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Maeckelberghe E, Zdunek K, Marceglia S, Farsides B, Rigby M. The ethical challenges of personalized digital health. Front Med (Lausanne) 2023; 10:1123863. [PMID: 37404804 PMCID: PMC10316710 DOI: 10.3389/fmed.2023.1123863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/09/2023] [Indexed: 07/06/2023] Open
Abstract
Personalized digital health systems (pHealth) bring together in sharp juxtaposition very different yet hopefully complementary moral principles in the shared objectives of optimizing health care and the health status of individual citizens while maximizing the application of robust clinical evidence through harnessing powerful and often complex modern data-handling technologies. Principles brought together include respecting the confidentiality of the patient-clinician relationship, the need for controlled information sharing in teamwork and shared care, benefitting from healthcare knowledge obtained from real-world population-level outcomes, and the recognition of different cultures and care settings. This paper outlines the clinical process as enhanced through digital health, reports on the examination of the new issues raised by the computerization of health data, outlines initiatives and policies to balance the harnessing of innovation with control of adverse effects, and emphasizes the importance of the context of use and citizen and user acceptance. The importance of addressing ethical issues throughout the life cycle of design, provision, and use of a pHealth system is explained, and a variety of situation-relevant frameworks are presented to enable a philosophy of responsible innovation, matching the best use of enabling technology with the creation of a culture and context of trustworthiness.
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Affiliation(s)
- Els Maeckelberghe
- Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Kinga Zdunek
- Health Education Unit, Medical University of Lublin, Lublin, Poland
| | - Sara Marceglia
- Faculty of Clinical Engineering, University of Trieste, Trieste, Italy
| | - Bobbie Farsides
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Michael Rigby
- School of Social, Political and Global Studies and School of Primary, Community and Social Care, Keele University, Keele, United Kingdom
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2
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Zakaria N, Zakaria N, Alnobani O, AlMalki M, El-Hassan O, Alhefzi MI, Househ M, Jamal A. Unlocking the eHealth professionals' career pathways: A case of Gulf Cooperation Council countries. Int J Med Inform 2023; 170:104914. [PMID: 36521421 DOI: 10.1016/j.ijmedinf.2022.104914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND During the past two decades, various sectors and industries have undergone digital transformation. Healthcare is poised to make a full transformation in the near future. Although steps have been taken toward creating an infrastructure for digital health in the Middle East, as it stands, digital health is still an emerging field here. The current global health care crisis has underscoredthe need for digitization of the healthcare sector to provide high-value, high-quality care and knowledge generation. With the advent of digital transformation in countries around the globe, there is a rising demand for investment and innovation in health information technology. With the demand for health informatics (HI) graduates in different disciplines (e.g., healthcare professions, information technology, etc.), there is an urgent need to determine and regulate clear career pathways and the core competencies necessary for digital health professional to practice effectively and to allow technology to add value to the healthcare systems. Given the changing landscape of the profession, the Kingdom of Saudi Arabia (KSA) and the Gulf Cooperation Council (GCC) countries are experiencing a rising demand to produce digital health professionals who can meet the needs of all the stakeholders involved, including patients, healthcare professionals, managers, and policymakers. However, despite the number of region-wide initiatives in the form of training programs, there remains a knowledge-practice gap and unclear job roles within the HI community. In recent years, regional digital health workforce initiatives have been put forward, such as the GCC Taskforce on Workforce Development in Digital Healthcare. The taskforce initiated a survey and several workshops to identify and classify HI disciplines according to the needs of the job market and through comparisons with similar efforts developed across the globe, such as the TIGER project and the EU*US eHealth Work project. Digital health implementation has been flourishing in the Middle East for the past 15 years. During this period, while digital health professions have been thriving in the industry to deliver tools and technologies, academic institutions have offered some amount of training and education in digital health; however, the career pathway for digital health professionals is not clear due to mismatch about the qualifications, skills, competencies and experience needed by the healthcare industry. OBJECTIVES Due to this discrepancy between the academic curriculum and the skills needed in the healthcare industry, the objectives of this study are to define the career pathway for eHealth professions and identify the challenges experienced by academic institutions and the industry in describing digital health professionals. METHODS We elicited qualitative data by conducting six focus groups with individuals from different professional backgrounds, including healthcare workers, information managers, computer sciences professionals, and workers in the revenue cycle who participated in a workshop on November 2-3, 2019, in Dubai. All focus group sessions were audio-recorded and transcribed, and participants were de-identified before analysis. An exploratory method was used to identify themes and subthemes. Saturation was reached when similar responses were found during the analysis. In this study, we found that respondents clearly defined eHealth career pathways based on criteria that included qualifications, experience, job scope, and competency. We also explored the challenges that the respondents encountered, including differences in the required skill sets and training and the need to standardize the academic curriculum across the GCC region, to recognize the various career pathways, and to develop local training programs. Additionally, country-specific projects have been initiated, such as the competency-based Digital Health framework, which was developed by the Saudi Commission of Healthcare Specialties (SCFHS) in 2018. Competency-based digital health frameworks generally include relevant job definitions, roles, and recommended competencies. Both the GCC taskforce and the Saudi studies capitalized on previous efforts by professional organizations, including Canada's Digital Health formerly known as (COACH), the U.S. Office of the National Coordinator for Health Information Technology (ONC), the American Medical Informatics Association (AMIA), and the Health Information and Management Systems Society (HIMSS). RESULTS In this study, we found that respondents defined eHealth career pathways based on different criteria such as: qualifications; various background of health and IT in the HI field; work experiences; job scope and competency. We also further explore the challenges that the respondents encountered which delineates four key aspects such as need of hybrid skills to manage the digital transformation, need of standardization of academic curriculum across GCC, recognition of the career pathways by the industry in order to open up career opportunity and career advancement, and availability of local training programs for up-skilling the current health workforce. CONCLUSION We believe that successful health digital transformation is not limited to technology advancement but requires an adaptive change in: the related competency-based frameworks, the organisation of work and career paths for eHealth professionals, and the development of educational programmes and joint degrees to equip clinicians with understanding of technology, and informaticians with understanding of healthcare. We anticipate that this work will be expanded and adopted by relevant professional and scientific bodies in the GCC region.
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Affiliation(s)
- Nasriah Zakaria
- Ehealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Health Information Systems, College of Applied Science, Al Maarefa University, Riyadh, Saudi Arabia
| | - Norhayati Zakaria
- Department of Management, College of Business Administration, University of Sharjah, United Arab Emirates
| | - Omar Alnobani
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Manal AlMalki
- Department of Health Informatics, Faculty of Public Health & Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Mohammed I Alhefzi
- Saudi Association for Health Informatics (SAHI), Riyadh, Saudi Arabia; Pfizer Digital, Pfizer, Riyadh, Saudi Arabia
| | - Mowafa Househ
- College of Science and Engineering, Hamad bin Khalifa University, Qatar
| | - Amr Jamal
- Evidence-Based Health Care & Knowledge Translation Research Chair, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Rams, hounds and white boxes: Investigating human-AI collaboration protocols in medical diagnosis. Artif Intell Med 2023; 138:102506. [PMID: 36990586 DOI: 10.1016/j.artmed.2023.102506] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/23/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023]
Abstract
In this paper, we study human-AI collaboration protocols, a design-oriented construct aimed at establishing and evaluating how humans and AI can collaborate in cognitive tasks. We applied this construct in two user studies involving 12 specialist radiologists (the knee MRI study) and 44 ECG readers of varying expertise (the ECG study), who evaluated 240 and 20 cases, respectively, in different collaboration configurations. We confirm the utility of AI support but find that XAI can be associated with a "white-box paradox", producing a null or detrimental effect. We also find that the order of presentation matters: AI-first protocols are associated with higher diagnostic accuracy than human-first protocols, and with higher accuracy than both humans and AI alone. Our findings identify the best conditions for AI to augment human diagnostic skills, rather than trigger dysfunctional responses and cognitive biases that can undermine decision effectiveness.
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Kooij L, van Harten WH. Strengthening the evidence base for mHealth in clinical practice: Conducting research with standalone or interoperable systems - a viewpoint. Digit Health 2023; 9:20552076231216551. [PMID: 38107980 PMCID: PMC10725093 DOI: 10.1177/20552076231216551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
Objective The aim of this viewpoint is to inform mobile health (mHealth) evidence development in using standalone or interoperable systems in hospital practice. Methods There is a gap between mHealth research and its widespread uptake in clinical practice. Evidence generation is not keeping up with the introduction and implementation of technologies. This is partly a consequence of the technology characteristics and the way research is conducted in a clinical setting. Research and development of mHealth technology can be conducted standalone in a laboratory like setting, standalone in a clinical setting or interoperable with already existing technology in hospital practice. Results Standalone systems operate relatively independent from an organizations' existing infrastructure. Using laboratory settings does not reflect the complexity of real-life, but in clinical practice this may be suitable for research assessing usability, feasibility or even clinical and process outcomes at a small scale. Realizing research and development on interoperable mHealth technology solutions, especially with operational EMR systems, is a challenging, time- and resource intensive process and requires large(r) investments, as it is often complicated by a myriad of interfering factors. Interoperable systems are however a more sustainable option in the long run, and generated evidence reflects the real hospital care setting and this option may therefore facilitate dissemination. Choosing either a standalone or interoperable setting affects the research design, the implementation pace and ultimately widespread adoption of the mHealth technology. Conclusion We recommend to include these technology characteristics in implementation frameworks and think of evaluation research designs in an early phase.
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Affiliation(s)
| | - Wim H van Harten
- Rijnstate Hospital, Arnhem, The Netherlands
- Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Abstract
Background Antimicrobial stewardship (AMS) programmes in hospitals support optimal antimicrobial use by utilizing strategies such as restriction policies and education. Several systematic reviews on digital interventions supporting AMS have been conducted but they have focused on specific interventions and outcomes. Objectives To provide a systematic overview and synthesis of evidence on the effectiveness of digital interventions to improve antimicrobial prescribing and monitoring in hospitals. Methods Multiple databases were searched from 2010 onwards. Review papers were eligible if they included studies that examined the effectiveness of AMS digital interventions in an inpatient hospital setting. Papers were excluded if they were not systematic reviews, were limited to a paediatric setting, or were not in English. Results Eight systematic reviews were included for data extraction. A large number of digital interventions were evaluated, with a strong focus on clinical decision support. Due to the heterogeneity of the interventions and outcome measures, a meta-analysis could not be performed. The majority of reviews reported that digital interventions reduced antimicrobial use and improved antimicrobial appropriateness. The impact of digital interventions on clinical outcomes was inconsistent. Conclusions Digital interventions reduce antimicrobial use and improve antimicrobial appropriateness in hospitals, but no firm conclusions can be drawn about the degree to which different types of digital interventions achieve these outcomes. Evaluation of sociotechnical aspects of digital intervention implementation is limited, despite the critical role that user acceptance, uptake and feasibility play in ensuring improvements in AMS are achieved with digital health.
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Affiliation(s)
| | - Jonathan Penm
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Angus Ritchie
- Health Informatics Unit, Sydney Local Health District, Camperdown, Australia
- The University of Sydney, Faculty of Medicine and Health, Concord Clinical School, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- The University of Sydney, Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, Sydney, New South Wales, Australia
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6
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Du J, Chen T, Zhang L. Measuring the Interactions Between Health Demand, Informatics Supply, and Technological Applications in Digital Medical Innovation for China: Content Mapping and Analysis. JMIR Med Inform 2021; 9:e26393. [PMID: 34255693 PMCID: PMC8292943 DOI: 10.2196/26393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There were 2 major incentives introduced by the Chinese government to promote medical informatics in 2009 and 2016. As new drugs are the major source of medical innovation, informatics-related concepts and techniques are a major source of digital medical innovation. However, it is unclear whether the research efforts of medical informatics in China have met the health needs, such as disease management and population health. OBJECTIVE We proposed an approach to mapping the interplay between different knowledge entities by using the tree structure of Medical Subject Headings (MeSH) to gain insights into the interactions between informatics supply, health demand, and technological applications in digital medical innovation in China. METHODS All terms under the MeSH tree parent node "Diseases [C]" or node "Health [N01.400]" or "Public Health [N06.850]" were labelled as H. All terms under the node "Information Science [L]" were labelled as I, and all terms under node "Analytical, Diagnostic and Therapeutic Techniques, and Equipment [E]" were labelled as T. The H-I-T interactions can be measured by using their co-occurrences in a given publication. RESULTS The H-I-T interactions in China are showing significant growth and a more concentrated interplay were observed. Computing methodologies, informatics, and communications media (such as social media and the internet) constitute the majority of I-related concepts and techniques used for resolving the health promotion and diseases management problems in China. Generally there is a positive correlation between the burden and informatics research efforts for diseases in China. We think it is not contradictory that informatics research should be focused on the greatest burden of diseases or where it can have the most impact. Artificial intelligence is a competing field of medical informatics research in China, with a notable focus on diagnostic deep learning algorithms for medical imaging. CONCLUSIONS It is suggested that technological transfers, namely the functionality to be realized by medical/health informatics (eg, diagnosis, therapeutics, surgical procedures, laboratory testing techniques, and equipment and supplies) should be strengthened. Research on natural language processing and electronic health records should also be strengthened to improve the real-world applications of health information technologies and big data in the future.
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Affiliation(s)
- Jian Du
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Ting Chen
- Institutes of Science and Development, Chinese Academy of Sciences, Beijing, China
| | - Luxia Zhang
- National Institute of Health Data Science, Peking University, Beijing, China
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7
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Fernandez-Luque L, Kushniruk AW, Georgiou A, Basu A, Petersen C, Ronquillo C, Paton C, Nøhr C, Kuziemsky CE, Alhuwail D, Skiba D, Huesing E, Gabarron E, Borycki EM, Magrabi F, Denecke K, Peute LWP, Topaz M, Al-Shorbaji N, Lacroix P, Marcilly R, Cornet R, Gogia SB, Kobayashi S, Iyengar S, Deserno TM, Mettler T, Vimarlund V, Zhu X. Evidence-Based Health Informatics as the Foundation for the COVID-19 Response: A Joint Call for Action. Methods Inf Med 2021; 59:183-192. [PMID: 33975375 PMCID: PMC8279811 DOI: 10.1055/s-0041-1726414] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background
As a major public health crisis, the novel coronavirus disease 2019 (COVID-19) pandemic demonstrates the urgent need for safe, effective, and evidence-based implementations of digital health. The urgency stems from the frequent tendency to focus attention on seemingly high promising digital health interventions despite being poorly validated in times of crisis.
Aim
In this paper, we describe a joint call for action to use and leverage evidence-based health informatics as the foundation for the COVID-19 response and public health interventions. Tangible examples are provided for how the working groups and special interest groups of the International Medical Informatics Association (IMIA) are helping to build an evidence-based response to this crisis.
Methods
Leaders of working and special interest groups of the IMIA, a total of 26 groups, were contacted via e-mail to provide a summary of the scientific-based efforts taken to combat COVID-19 pandemic and participate in the discussion toward the creation of this manuscript. A total of 13 groups participated in this manuscript.
Results
Various efforts were exerted by members of IMIA including (1) developing evidence-based guidelines for the design and deployment of digital health solutions during COVID-19; (2) surveying clinical informaticians internationally about key digital solutions deployed to combat COVID-19 and the challenges faced when implementing and using them; and (3) offering necessary resources for clinicians about the use of digital tools in clinical practice, education, and research during COVID-19.
Discussion
Rigor and evidence need to be taken into consideration when designing, implementing, and using digital tools to combat COVID-19 to avoid delays and unforeseen negative consequences. It is paramount to employ a multidisciplinary approach for the development and implementation of digital health tools that have been rapidly deployed in response to the pandemic bearing in mind human factors, ethics, data privacy, and the diversity of context at the local, national, and international levels. The training and capacity building of front-line workers is crucial and must be linked to a clear strategy for evaluation of ongoing experiences.
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Affiliation(s)
| | - Andre W Kushniruk
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, Macquarie, New South Wales, Australia
| | - Arindam Basu
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Carolyn Petersen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Charlene Ronquillo
- Daphne Cockwell School of Nursing, Ryerson University, Ryerson, Toronto, Canada
| | - Chris Paton
- Department of Information Science, University of Otago, Dunedin, New Zealand.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Christian Nøhr
- Centre for Health Informatics and Technology, Maersk McKinney Moller Institute, University of Southern Denmark, Denmark
| | - Craig E Kuziemsky
- Office of Research Services, MacEwan University, Edmonton, AB, Canada
| | - Dari Alhuwail
- Department of Information Science, Kuwait University, Kuwait.,Health Informatics Unit, Dasman Diabetes Institute, Kuwait
| | - Diane Skiba
- University of Colorado, Denver, Colorado, United States
| | | | - Elia Gabarron
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Elizabeth M Borycki
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Farah Magrabi
- Australian Institute of Health Innovation, Macquarie University, Macquarie, New South Wales, Australia
| | - Kerstin Denecke
- Institute for Medical Informatics, Bern University of Applied Sciences, Bern, Switzerland
| | - Linda W P Peute
- Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Max Topaz
- Columbia University Medical Center, Data Science Institute, Columbia University, Columbia, United States
| | | | | | - Romaric Marcilly
- Univ. Lille, Inserm, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Ronald Cornet
- Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Shashi B Gogia
- Society for Administration of Telemedicine and Healthcare Informatics, New Delhi, India
| | | | | | - Thomas M Deserno
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany
| | - Tobias Mettler
- Swiss Graduate School of Public Administration, University of Lausanne, Lausanne, Switzerland
| | - Vivian Vimarlund
- Department of Computer and Information Science (IDA), School of Engineering and Technology, Linköping University, Linköping, Sweden
| | - Xinxin Zhu
- Center for Biomedical Data Science, Yale University, New Haven, Connecticut, United States
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8
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Tsai CH, Eghdam A, Davoody N, Wright G, Flowerday S, Koch S. Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content. Life (Basel) 2020; 10:E327. [PMID: 33291615 PMCID: PMC7761950 DOI: 10.3390/life10120327] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
Abstract
Despite the great advances in the field of electronic health records (EHRs) over the past 25 years, implementation and adoption challenges persist, and the benefits realized remain below expectations. This scoping review aimed to present current knowledge about the effects of EHR implementation and the barriers to EHR adoption and use. A literature search was conducted in PubMed, Web of Science, IEEE Xplore Digital Library and ACM Digital Library for studies published between January 2005 and May 2020. In total, 7641 studies were identified of which 142 met the criteria and attained the consensus of all researchers on inclusion. Most studies (n = 91) were published between 2017 and 2019 and 81 studies had the United States as the country of origin. Both positive and negative effects of EHR implementation were identified, relating to clinical work, data and information, patient care and economic impact. Resource constraints, poor/insufficient training and technical/educational support for users, as well as poor literacy and skills in technology were the identified barriers to adoption and use that occurred frequently. Although this review did not conduct a quality analysis of the included papers, the lack of uniformity in the use of EHR definitions and detailed contextual information concerning the study settings could be observed.
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Affiliation(s)
- Chen Hsi Tsai
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| | - Aboozar Eghdam
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| | - Nadia Davoody
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| | - Graham Wright
- Department of Information Systems, Rhodes University, Grahamstown 6140, South Africa; (G.W.); (S.F.)
| | - Stephen Flowerday
- Department of Information Systems, Rhodes University, Grahamstown 6140, South Africa; (G.W.); (S.F.)
| | - Sabine Koch
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
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9
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Hoffmann M, Vander Stichele R, Bates DW, Björklund J, Alexander S, Andersson ML, Auraaen A, Bennie M, Dahl ML, Eiermann B, Hackl W, Hammar T, Hjemdahl P, Koch S, Kunnamo I, Le Louët H, Panagiotis P, Rägo L, Spedding M, Seidling HM, Demner-Fushman D, Gustafsson LL. Guiding principles for the use of knowledge bases and real-world data in clinical decision support systems: report by an international expert workshop at Karolinska Institutet. Expert Rev Clin Pharmacol 2020; 13:925-934. [DOI: 10.1080/17512433.2020.1805314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mikael Hoffmann
- The NEPI Foundation - Swedish Network for Pharmacoepidemiology, Linköping University, Linköping, Sweden
| | - Robert Vander Stichele
- Clinical Pharmacology Research Unit, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | - David W Bates
- Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Steve Alexander
- School of Life Sciences, University of Nottingham Medical School, Nottingham, UK
| | - Marine L Andersson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ane Auraaen
- Organisation for Economic Cooperation and Development (OECD), Paris, France
| | - Marion Bennie
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Marja-Liisa Dahl
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Birgit Eiermann
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Werner Hackl
- Institute of Medical Informatics, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Tora Hammar
- E-health Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Paul Hjemdahl
- Clinical Pharmacology Unit, Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sabine Koch
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ilkka Kunnamo
- The Finnish Medical Society Duodecim, Helsinki, Finland
| | - Herve Le Louët
- Council for International Organizations of Medical Sciences (CIOMS), Geneva, Switzerland
| | | | - Lembit Rägo
- Council for International Organizations of Medical Sciences (CIOMS), Geneva, Switzerland
| | - Michael Spedding
- International Union of Basic and Clinical Pharmacology (IUPHAR), Paris, France
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Dina Demner-Fushman
- National Library of Medicine, National Institutes of Health, HHS, Bethesda, MD, USA
| | - Lars L Gustafsson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Swedish Institute for Drug Informatics (SIDI), Stockholm, Sweden
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10
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Scott IA, Sullivan C, Staib A. Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation. AUST HEALTH REV 2020; 43:302-313. [PMID: 29792259 DOI: 10.1071/ah17153] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/29/2018] [Indexed: 11/23/2022]
Abstract
Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads. Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation). Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation. What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care. What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care. What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.
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Affiliation(s)
- Ian A Scott
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
| | - Clair Sullivan
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
| | - Andrew Staib
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
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11
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Jurkeviciute M, Eriksson H. Exploring the Use of Evidence From the Development and Evaluation of an Electronic Health (eHealth) Trial: Case Study. J Med Internet Res 2020; 22:e17718. [PMID: 32857057 PMCID: PMC7486667 DOI: 10.2196/17718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/21/2020] [Accepted: 06/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence-based practice refers to building clinical decisions on credible research evidence, professional experience, and patient preferences. However, there is a growing concern that evidence in the context of electronic health (eHealth) is not sufficiently used when forming policies and practice of health care. In this context, using evaluation and research evidence in clinical or policy decisions dominates the discourse. However, the use of additional types of evidence, such as professional experience, is underexplored. Moreover, there might be other ways of using evidence than in clinical or policy decisions. OBJECTIVE This study aimed to analyze how different types of evidence (such as evaluation outcomes [including patient preferences], professional experiences, and existing scientific evidence from other research) obtained within the development and evaluation of an eHealth trial are used by diverse stakeholders. An additional aim was to identify barriers to the use of evidence and ways to support its use. METHODS This study was built on a case of an eHealth trial funded by the European Union. The project included 4 care centers, 2 research and development companies that provided the web-based physical exercise program and an activity monitoring device, and 2 science institutions. The qualitative data collection included 9 semistructured interviews conducted 8 months after the evaluation was concluded. The data analysis concerned (1) activities and decisions that were made based on evidence after the project ended, (2) evidence used for those activities and decisions, (3) in what way the evidence was used, and (4) barriers to the use of evidence. RESULTS Evidence generated from eHealth trials can be used by various stakeholders for decisions regarding clinical integration of eHealth solutions, policy making, scientific publishing, research funding applications, eHealth technology, and teaching. Evaluation evidence has less value than professional experiences to local decision making regarding eHealth integration into clinical practice. Professional experiences constitute the evidence that is valuable to the highest variety of activities and decisions in relation to eHealth trials. When using existing scientific evidence related to eHealth trials, it is important to consider contextual relevance, such as location or disease. To support the use of evidence, it is suggested to create possibilities for health care professionals to gain experience, assess a few rather than a large number of variables, and design for shorter iterative cycles of evaluation. CONCLUSIONS Initiatives to support and standardize evidence-based practice in the context of eHealth should consider the complexities in how the evidence is used in order to achieve better uptake of evidence in practice. However, one should be aware that the assumption of fact-based decision making in organizations is misleading. In order to create better chances that the evidence produced would be used, this should be addressed through the design of eHealth trials.
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Affiliation(s)
- Monika Jurkeviciute
- Centre for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Henrik Eriksson
- Centre for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
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12
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Jurkeviciute M. Standards as applied in reality: a case study on the translation of standards in eHealth evaluation practice. BMC Med Inform Decis Mak 2019; 19:247. [PMID: 31783847 PMCID: PMC6884841 DOI: 10.1186/s12911-019-0975-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/08/2019] [Indexed: 11/18/2022] Open
Abstract
Background Application of standards is a way to increase quality in an evaluation study. However, standards are used insufficiently in eHealth evaluation, affecting the generalization of the knowledge generated. This study aimed to explore how standards are used in a practical setting of an eHealth evaluation, and to identify the factors that can hinder their use. Methods The data were collected in a multi-national and interdisciplinary eHealth evaluation study targeted at the elderly people suffering from mild cognitive impairment and mild dementia. The study was carried out in four countries and funded by the European Union. The collected data included meeting minutes (n = 8) and e-mail correspondence (n = 261) between partners. The chronological sequence of events related to the use of standards was established. Subsequently, the hindering factors related to the use of standards were identified from the sequence. Results The use of four standards was described, reflecting a variety of related processes or barriers that emerge during eHealth evaluation. The processes differed based on the type of the standard. Specifically, evaluation frameworks were found to be conceptual standards and they were easy to agree upon, while standardized metrics were more tangible and their use triggered negotiations. Further, the following factors hindered the use of standards in eHealth evaluations: (1) inadequacy of a standard to address a target population or a disease, (2) insufficient resources to use a standard, (3) lack of experience in using a standard, and (4) lack of validation of a standard in a particular location. Conclusions Standardization initiatives in eHealth evaluation provide a blueprint for evaluation, but their practical application is problematic. The practical circumstances of an evaluation study can cause deviations in the standards, thus producing heterogeneity in the evaluation methodologies.
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Affiliation(s)
- Monika Jurkeviciute
- Centre for Healthcare Improvement (CHI), Chalmers University of Technology, 41296, Gothenburg, Sweden.
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13
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Amer YS, Wahabi HA, Abou Elkheir MM, Bawazeer GA, Iqbal SM, Titi MA, Ekhzaimy A, Alswat KA, Alzeidan RA, Al-Ansary LA. Adapting evidence-based clinical practice guidelines at university teaching hospitals: A model for the Eastern Mediterranean Region. J Eval Clin Pract 2019; 25:550-560. [PMID: 29691950 DOI: 10.1111/jep.12927] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 12/15/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines (CPGs) are significant tools for evidence-based health care quality improvement. The CPG program at King Saud University was launched as a quality improvement program to fulfil the international accreditation standards. This program was a collaboration between the Research Chair for Evidence-Based Healthcare and Knowledge Translation and the Quality Management Department. This study aims to develop a fast-track method for adaptation of evidence-based CPGs and describe results of the program. METHODS Twenty-two clinical departments participated in the program. Following a CPGs awareness week directed to all health care professionals (HCPs), 22 teams were trained to set priorities, search, screen, assess, select, and customize the best available CPGs. The teams were technically supported by the program's CPG advisors. To address the local health care context, a modified version of the ADAPTE was used where recommendations were either accepted or rejected but not changed. A strict peer-review process for clinical content and methodology was employed. RESULTS In addition to raising awareness and building capacity, 35 CPGs were approved for implementation by March 2018. These CPGs were integrated with other existing projects such as accreditation, electronic medical records, performance management, and training and education. Preliminary implementation audits suggest a positive impact on patient outcomes. Leadership commitment was a strength, but the high turnover of the team members required frequent and extensive training for HCPs. CONCLUSION This model for CPG adaptation represents a quick, practical, economical method with a sense of ownership by staff. Using this modified version can be replicated in other countries to assess its validity.
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Affiliation(s)
- Yasser S Amer
- Clinical Practice Guidelines Unit, Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt.,Guidelines International Network, Adaptation Working Group (Steering)
| | - Hayfaa A Wahabi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Manal M Abou Elkheir
- Pharmacy Services, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ghada A Bawazeer
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Pharmacy Services, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Shaikh M Iqbal
- Pediatrics Department, King Khalid University Hospital, King Saud University, Hospital, Riyadh, Saudi Arabia.,Department of Pediatrics and Child Health, University of Manitoba, College of Medicine, Manitoba, Canada
| | - Maher A Titi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Patient Safety Unit, Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Aishah Ekhzaimy
- Medicine Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid A Alswat
- Medicine Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Rasmieh A Alzeidan
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lubna A Al-Ansary
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Guidelines International Network, Adaptation Working Group (Steering).,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Health Metrics and Measurement, World Health Organization, Geneva, Switzerland
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14
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Georgiou A, Magrabi F, Hyppönen H, Wong ZSY, Nykänen P, Scott PJ, Ammenwerth E, Rigby M. The Safe and Effective Use of Shared Data Underpinned by Stakeholder Engagement and Evaluation Practice. Yearb Med Inform 2018; 27:25-28. [PMID: 29681039 PMCID: PMC6115216 DOI: 10.1055/s-0038-1641194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives:
The paper draws attention to: i) key considerations involving the confidentiality, privacy, and security of shared data; and ii) the requirements needed to build collaborative arrangements encompassing all stakeholders with the goal of ensuring safe, secure, and quality use of shared data.
Method:
A narrative review of existing research and policy approaches along with expert perspectives drawn from the International Medical Informatics Association (IMIA) Working Group on Technology Assessment and Quality Development in Health Care and the European Federation for Medical Informatics (EFMI) Working Group for Assessment of Health Information Systems.
Results:
The technological ability to merge, link, re-use, and exchange data has outpaced the establishment of policies, procedures, and processes to monitor the ethics and legality of shared use of data. Questions remain about how to guarantee the security of shared data, and how to establish and maintain public trust across large-scale shared data enterprises. This paper identifies the importance of data governance frameworks (incorporating engagement with all stakeholders) to underpin the management of the ethics and legality of shared data use. The paper also provides some key considerations for the establishment of national approaches and measures to monitor compliance with best practice.
Conclusion:
Data sharing endeavours can help to underpin new collaborative models of health care which provide shared information, engagement, and accountability amongst all stakeholders. We believe that commitment to rigorous evaluation and stakeholder engagement will be critical to delivering health data benefits and the establishment of collaborative models of health care into the future.
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Affiliation(s)
- Andrew Georgiou
- Macquarie University, Australian Institute of Health Innovation, Sydney, Australia
| | - Farah Magrabi
- Macquarie University, Australian Institute of Health Innovation, Sydney, Australia
| | - Hannele Hyppönen
- National Institute for Health and Welfare, Information Department, Helsinki, Finland
| | | | - Pirkko Nykänen
- University of Tampere, Faculty of Natural Sciences, Tampere, Finland
| | - Philip J Scott
- University of Portsmouth, Centre for Healthcare Modelling and Informatics, Portsmouth, United Kingdom
| | - Elske Ammenwerth
- UMIT, University for Health Sciences, Medical Informatics and Technology, Institute of Medical Informatics, Hall in Tyrol, Austria
| | - Michael Rigby
- Keele University, School of Social Science and Public Policy, Keele, United Kingdom
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15
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Al-Shorbaji N, Hanmer L, Hussein R, Magrabi F, Moen A, Moura LA, Park HA, Scott P. Discussion of “Evidence-based Health Informatics: How Do We Know What We Know?”. Methods Inf Med 2018. [DOI: 10.3414/me14-02-0119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
SummaryThis article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper “Evidence-based Health Informatics: How Do We Know What We Know?” written by Elske Ammenwerth [1]. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Ammenwerth paper. In subsequent issues the discussion can continue through letters to the editor.With these comments on the paper “Evidence-based Health Informatics: How do we know what we know?”, written by Elske Ammenwerth [1], the journal seeks to stimulate a broad discussion on the challenges of evaluating information processing and information technology in health care. An international group of experts has been invited by the editor of Methods to comment on this paper. Each of the invited commentaries forms one section of this paper.
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16
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Digital Health Research Methods and Tools: Suggestions and Selected Resources for Researchers. ADVANCES IN BIOMEDICAL INFORMATICS 2018. [DOI: 10.1007/978-3-319-67513-8_2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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17
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Pirnejad H, Niazkhani Z. Learning From Lessons on Applying Information Technology in Organ Transplant: A Stepping Stone to Achieve Electronic Health Record Meaningful Use. Am J Transplant 2017; 17:2494-2495. [PMID: 28556583 DOI: 10.1111/ajt.14373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 05/01/2017] [Accepted: 05/15/2017] [Indexed: 01/25/2023]
Affiliation(s)
- H Pirnejad
- Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran.,Inpatient's Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran.,Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Z Niazkhani
- Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran.,Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran
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18
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Winter A, Takabayashi K, Jahn F, Kimura E, Engelbrecht R, Haux R, Honda M, Hübner UH, Inoue S, Kohl CD, Matsumoto T, Matsumura Y, Miyo K, Nakashima N, Prokosch HU, Staemmler M. Quality Requirements for Electronic Health Record Systems*. A Japanese-German Information Management Perspective. Methods Inf Med 2017; 56:e92-e104. [PMID: 28925415 PMCID: PMC6291988 DOI: 10.3414/me17-05-0002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/13/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND For more than 30 years, there has been close cooperation between Japanese and German scientists with regard to information systems in health care. Collaboration has been formalized by an agreement between the respective scientific associations. Following this agreement, two joint workshops took place to explore the similarities and differences of electronic health record systems (EHRS) against the background of the two national healthcare systems that share many commonalities. OBJECTIVES To establish a framework and requirements for the quality of EHRS that may also serve as a basis for comparing different EHRS. METHODS Donabedian's three dimensions of quality of medical care were adapted to the outcome, process, and structural quality of EHRS and their management. These quality dimensions were proposed before the first workshop of EHRS experts and enriched during the discussions. RESULTS The Quality Requirements Framework of EHRS (QRF-EHRS) was defined and complemented by requirements for high quality EHRS. The framework integrates three quality dimensions (outcome, process, and structural quality), three layers of information systems (processes and data, applications, and physical tools) and three dimensions of information management (strategic, tactical, and operational information management). CONCLUSIONS Describing and comparing the quality of EHRS is in fact a multidimensional problem as given by the QRF-EHRS framework. This framework will be utilized to compare Japanese and German EHRS, notably those that were presented at the second workshop.
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Affiliation(s)
- Alfred Winter
- Prof. Alfred Winter, University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology, Haertelstr. 16 -18, 04107 Leipzig, Germany, E-mail:
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19
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Turner P, Kushniruk A, Nohr C. Are We There Yet? Human Factors Knowledge and Health Information Technology - the Challenges of Implementation and Impact. Yearb Med Inform 2017; 26:84-91. [PMID: 29063542 PMCID: PMC6239238 DOI: 10.15265/iy-2017-014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: To review the developments in human factors (HF) research on the challenges of health information technology (HIT) implementation and impact given the continuing incidence of usability problems and unintended consequences from HIT development and use. Methods: A search of PubMed/Medline and Web of Science® identified HF research published in 2015 and 2016. Electronic health records (EHRs) and patient-centred HIT emerged as significant foci of recent HF research. The authors selected prominent papers highlighting ongoing HF and usability challenges in these areas. This selective rather than systematic review of recent HF research highlights these key challenges and reflects on their implications on the future impact of HF research on HIT. Results: Research provides evidence of continued poor design, implementation, and usability of HIT, as well as technology-induced errors and unintended consequences. The paper highlights support for: (i) strengthening the evidence base on the benefits of HF approaches; (ii) improving knowledge translation in the implementation of HF approaches during HIT design, implementation, and evaluation; (iii) increasing transparency, governance, and enforcement of HF best practices at all stages of the HIT system development life cycle. Discussion and Conclusion: HF and usability approaches are yet to become embedded as integral components of HIT development, implementation, and impact assessment. As HIT becomes ever-more pervasive including with patients as end-users, there is a need to expand our conceptualisation of the problems to be addressed and the suite of tactics and strategies to be used to calibrate our pro-active involvement in its improvement.
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Affiliation(s)
- P. Turner
- eHealth Services Research Group (eHSRG), School of Engineering & ICT, University of Tasmania, Australia
| | - A. Kushniruk
- School of Health Information Science, University of Victoria, Victoria, Canada
- Department of Development and Planning, Aalborg University, Aalborg, Denmark
| | - C. Nohr
- Department of Development and Planning, Aalborg University, Aalborg, Denmark
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20
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Niazkhani Z, Pirnejad H, Rashidi Khazaee P. The impact of health information technology on organ transplant care: A systematic review. Int J Med Inform 2017; 100:95-107. [DOI: 10.1016/j.ijmedinf.2017.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 12/01/2016] [Accepted: 01/19/2017] [Indexed: 01/02/2023]
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21
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Campbell ML, Rankin JM. Nurses and electronic health records in a Canadian hospital: examining the social organisation and programmed use of digitised nursing knowledge. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:365-379. [PMID: 27726159 DOI: 10.1111/1467-9566.12489] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Institutional ethnography (IE) is used to examine transformations in a professional nurse's work associated with her engagement with a hospital's electronic health record (EHR) which is being updated to integrate professional caregiving and produce more efficient and effective health care. We review in the technical and scholarly literature the practices and promises of information technology and, especially of its applications in health care, finding useful the more critical and analytic perspectives. Among the latter, scholarship on the activities of economising is important to our inquiry into the actual activities that transform 'things' (in our case, nursing knowledge and action) into calculable information for objective and financially relevant decision-making. Beginning with an excerpt of observational data, we explicate observed nurse-patient interactions, discovering in them traces of institutional ruling relations that the nurse's activation of the EHR carries into the nursing setting. The EHR, we argue, materialises and generalises the ruling relations across institutionally located caregivers; its authorised information stabilises their knowing and acting, shaping health care towards a calculated effective and efficient form. Participating in the EHR's ruling practices, nurses adopt its ruling standpoint; a transformation that we conclude needs more careful analysis and debate.
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Haux R, Kulikowski CA, Bakken S, de Lusignan S, Kimura M, Koch S, Mantas J, Maojo V, Marschollek M, Martin-Sanchez F, Moen A, Park HA, Sarkar IN, Leong TY, McCray AT. Research Strategies for Biomedical and Health Informatics. Some Thought-provoking and Critical Proposals to Encourage Scientific Debate on the Nature of Good Research in Medical Informatics. Methods Inf Med 2017; 56:e1-e10. [PMID: 28119991 PMCID: PMC5388922 DOI: 10.3414/me16-01-0125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 11/17/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medical informatics, or biomedical and health informatics (BMHI), has become an established scientific discipline. In all such disciplines there is a certain inertia to persist in focusing on well-established research areas and to hold on to well-known research methodologies rather than adopting new ones, which may be more appropriate. OBJECTIVES To search for answers to the following questions: What are research fields in informatics, which are not being currently adequately addressed, and which methodological approaches might be insufficiently used? Do we know about reasons? What could be consequences of change for research and for education? METHODS Outstanding informatics scientists were invited to three panel sessions on this topic in leading international conferences (MIE 2015, Medinfo 2015, HEC 2016) in order to get their answers to these questions. RESULTS A variety of themes emerged in the set of answers provided by the panellists. Some panellists took the theoretical foundations of the field for granted, while several questioned whether the field was actually grounded in a strong theoretical foundation. Panellists proposed a range of suggestions for new or improved approaches, methodologies, and techniques to enhance the BMHI research agenda. CONCLUSIONS The field of BMHI is on the one hand maturing as an academic community and intellectual endeavour. On the other hand vendor-supplied solutions may be too readily and uncritically accepted in health care practice. There is a high chance that BMHI will continue to flourish as an important discipline; its innovative interventions might then reach the original objectives of advancing science and improving health care outcomes.
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Affiliation(s)
- Reinhold Haux
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig and Hannover Medical School, Germany
| | - Casimir A. Kulikowski
- Department of Computer Science, Rutgers – The State University of New Jersey, NJ, USA
| | - Suzanne Bakken
- School of Nursing and Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Michio Kimura
- Medical Informatics Department, School of Medicine, Hamamatsu University, Shizuoka, Japan
| | - Sabine Koch
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden
| | - John Mantas
- Health Informatics Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Victor Maojo
- Biomedical Informatics Group, Artificial Intelligence Department, Universidad Politecnica de Madrid, Madrid, Spain
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig and Hannover Medical School, Germany
| | - Fernando Martin-Sanchez
- Department of Healthcare Policy and Research, Division of Health Informatics, Weill Cornell Medicine, New York, NY, USA
| | - Anne Moen
- Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute for Health Sciences, University College of South East Norway, Drammen, Norway
| | - Hyeoun-Ae Park
- College of Nursing and Systems Biomedical Informatics Research Center, Seoul National University, Seoul, Republic of Korea
| | - Indra Neil Sarkar
- Center for Biomedical Informatics, Brown University, Providence, RI, USA
| | - Tze Yun Leong
- Medical Computing Laboratory, School of Computing, National University of Singapore, Singapore
- School of Information Systems, Singapore Management University, Singapore
| | - Alexa T. McCray
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
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Pelayo S, Santos R. Human Factors and Organizational Issues in 2015: The Increasing Complexity of the Healthcare Domain Calls for More Comprehensive Approaches. Yearb Med Inform 2016:126-129. [PMID: 27830240 DOI: 10.15265/iy-2016-043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To summarize significant research contributions on human factors and organizational issues in medical informatics published in 2015. METHODS An extensive search using PubMed/Medline and Web of Science® was conducted to identify the scientific contributions published in 2015 that address human factors and organizational issues in medical informatics. The selection process comprised three steps: (i) 15 candidate best papers were first selected by the two section editors, (ii) external reviewers from internationally renowned research teams reviewed each candidate best paper, and (iii) the final selection of five best papers was conducted by the editorial board of the Yearbook. RESULTS Noteworthy papers in 2015 emphasize the increasing complexity of the healthcare environment. They call for more comprehensive approaches and evaluation studies. All provide a real added-value in this direction. CONCLUSION There is no more need to promote the contribution of human factors and ergonomics (HFE) approaches to health IT-related risks and patient safety. However, there is still a need for research on HFE methods to adapt health information technology tools to the complexity of the healthcare domain.
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Affiliation(s)
- S Pelayo
- S. Pelayo, INSERM CIC-IT 1403 Evalab, CHU Lille, UDSL EA 2694, Lille University, F-59000, Lille, France, E-mail:
| | - R Santos
- R. Santos, HOSPITAL DA LUZ - LEARNING HEALTH, R. Carlos Alberto da Mota Pinto, 17-9º, 1070-313 Lisboa, Portugal, E-mail:
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Hwang IC, Lee KW, Park SS, Chanthanoulay S, Sisavanh M, Rajpho V, Kim M, Billamay S, Phangmanixay S, Oudavong B. The first picture archiving and communication system in Lao People's Democratic Republic: Changes in the utilization rate of imaging tests in the first year after implementation. Int J Med Inform 2016; 94:31-8. [PMID: 27573309 DOI: 10.1016/j.ijmedinf.2016.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 06/18/2016] [Accepted: 06/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implementation of the Picture Archiving and Communication System (PACS) is more challenging in developing countries than in developed countries. Given that the first PACS in Lao People's Democratic Republic (PDR) was successfully installed at the Children's Hospital of Lao PDR, we aimed to investigate whether the utilization rate of imaging tests increased after PACS implementation. METHODS PACS was implemented at the Children's Hospital of Lao PDR in December 2014. We compared the utilization rates of imaging tests including X-ray and ultrasound examinations between the pre-PACS period (from December 2013 to November 2014) and the post-PACS period (from December 2014 to November 2015). The utilization rate was defined as the number of imaging tests divided by the number of patients per month. RESULTS The average number of total imaging tests was 225.8/month (standard deviation [SD], 37.7) during the 1-year pre-PACS period and was 269.4/month (SD, 38.5) during the 1-year post-PACS period (P=0.0103). The utilization rate of total imaging tests significantly increased after PACS implementation (pre-PACS, 2.47%/month; post-PACS, 4.23%/month; P<0.0001). Increased utilization rates were observed for both X-rays (pre-PACS, 1.65%/month; post-PACS, 2.38%/month; P=0.0004) and ultrasound examinations (pre-PACS, 0.82%/month; post-PACS, 1.85%/month; P=0.0001). CONCLUSIONS The implementation of PACS at the Children's Hospital of Lao PDR resulted in a significant increase in the utilization rate of imaging tests, suggesting the indirect benefit of improved quality of care. Our findings showed that the benefits of PACS can be realized even in a resource-limited country such as Lao PDR.
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Affiliation(s)
- In-Chang Hwang
- Korea International Cooperation Agency (KOICA) Lao PDR Office, Vientiane, Lao Democratic People's Republic; Cardiovascular Unit, Children's Hospital, Vientiane, Lao Democratic People's Republic; Department of Radiology, Children's Hospital, Vientiane, Lao Democratic People's Republic; Cardiovascular Center & Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Kil Won Lee
- Korea International Cooperation Agency (KOICA) Lao PDR Office, Vientiane, Lao Democratic People's Republic; Department of Radiology, Children's Hospital, Vientiane, Lao Democratic People's Republic
| | - Sang Soon Park
- Korea International Cooperation Agency (KOICA) Lao PDR Office, Vientiane, Lao Democratic People's Republic; Department of Radiology, Children's Hospital, Vientiane, Lao Democratic People's Republic
| | - Siamphone Chanthanoulay
- Department of Radiology, Children's Hospital, Vientiane, Lao Democratic People's Republic; Lee Jong-Wook Fellowship Program, JW LEE Center for Global Medicine, Seoul National University & Korea Foundation for International Healthcare (KOFIH), Seoul, Republic of Korea; Department of Pediatrics, Children's Hospital, Vientiane, Lao Democratic People's Republic
| | - Malouny Sisavanh
- Cardiovascular Unit, Children's Hospital, Vientiane, Lao Democratic People's Republic; Lee Jong-Wook Fellowship Program, JW LEE Center for Global Medicine, Seoul National University & Korea Foundation for International Healthcare (KOFIH), Seoul, Republic of Korea; Department of Pediatrics, Children's Hospital, Vientiane, Lao Democratic People's Republic
| | - Virasack Rajpho
- Department of Radiology, Children's Hospital, Vientiane, Lao Democratic People's Republic; University of Health Sciences, Lao Democratic People's Republic
| | - Mijin Kim
- Korea International Cooperation Agency (KOICA) Lao PDR Office, Vientiane, Lao Democratic People's Republic
| | - Somxay Billamay
- Department of Pediatrics, Children's Hospital, Vientiane, Lao Democratic People's Republic
| | | | - Bounleua Oudavong
- Department of Pediatrics, Children's Hospital, Vientiane, Lao Democratic People's Republic; University of Health Sciences, Lao Democratic People's Republic
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Haux R, Koch S, Lovell N, Marschollek M, Nakashima N, Wolf KH. Health-Enabling and Ambient Assistive Technologies: Past, Present, Future. Yearb Med Inform 2016; Suppl 1:S76-91. [PMID: 27362588 PMCID: PMC5171510 DOI: 10.15265/iys-2016-s008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND During the last decades, health-enabling and ambient assistive technologies became of considerable relevance for new informatics-based forms of diagnosis, prevention, and therapy. OBJECTIVES To describe the state of the art of health-enabling and ambient assistive technologies in 1992 and today, and its evolution over the last 25 years as well as to project where the field is expected to be in the next 25 years. In the context of this review, we define health-enabling and ambient assistive technologies as ambiently used sensor-based information and communication technologies, aiming at contributing to a person's health and health care as well as to her or his quality of life. METHODS Systematic review of all original articles with research focus in all volumes of the IMIA Yearbook of Medical Informatics. Surveying authors independently on key projects and visions as well as on their lessons learned in the context of health-enabling and ambient assistive technologies and summarizing their answers. Surveying authors independently on their expectations for the future and summarizing their answers. RESULTS IMIA Yearbook papers containing statements on health-enabling and ambient assistive technologies appear first in 2002. These papers form a minor part of published research articles in medical informatics. However, during recent years the number of articles published has increased significantly. Key projects were identified. There was a clear progress on the use of technologies. However proof of diagnostic relevance and therapeutic efficacy remains still limited. Reforming health care processes and focussing more on patient needs are required. CONCLUSIONS Health-enabling and ambient assistive technologies remain an important field for future health care and for interdisciplinary research. More and more publications assume that a person's home and their interaction therein, are becoming important components in health care provision, assessment, and management.
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Affiliation(s)
- R. Haux
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig - Institute of Technology and Hannover Medical School, Germany
| | - S. Koch
- Health Informatics Centre, LIME, Karolinska Institutet, Stockholm, Sweden
| | - N.H. Lovell
- Graduate School of Biomedical Engineering, UNSW, Sydney, Australia
| | - M. Marschollek
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig - Institute of Technology and Hannover Medical School, Germany
| | - N. Nakashima
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - K.-H. Wolf
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig - Institute of Technology and Hannover Medical School, Germany
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Abstract
OBJECTIVES To review the history of clinical information systems over the past twenty-five years and project anticipated changes to those systems over the next twenty-five years. METHODS Over 250 Medline references about clinical information systems, quality of patient care, and patient safety were reviewed. Books, Web resources, and the author's personal experience with developing the HELP system were also used. RESULTS There have been dramatic improvements in the use and acceptance of clinical computing systems and Electronic Health Records (EHRs), especially in the United States. Although there are still challenges with the implementation of such systems, the rate of progress has been remarkable. Over the next twenty-five years, there will remain many important opportunities and challenges. These opportunities include understanding complex clinical computing issues that must be studied, understood and optimized. Dramatic improvements in quality of care and patient safety must be anticipated as a result of the use of clinical information systems. These improvements will result from a closer involvement of clinical informaticians in the optimization of patient care processes. CONCLUSIONS Clinical information systems and computerized clinical decision support have made contributions to medicine in the past. Therefore, by using better medical knowledge, optimized clinical information systems, and computerized clinical decision, we will enable dramatic improvements in both the quality and safety of patient care in the next twenty-five years.
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Affiliation(s)
- R M Gardner
- Reed M. Gardner, PhD, Professor Emeritus, Department of Biomedical Informatics, University of Utah, 1745 Cornell Circle (Home Address), Salt Lake City, UT 84108, Tel: +1 801 581 1164, Cell: +1 801 455 8207, E-mail:
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Ossebaard HC, Van Gemert-Pijnen L. eHealth and quality in health care: implementation time. Int J Qual Health Care 2016; 28:415-9. [PMID: 27029590 DOI: 10.1093/intqhc/mzw032] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 12/14/2022] Open
Abstract
The use of information and communication technologies in health and health care could improve healthcare quality in many ways. Today's evidence base demonstrates the (cost-)effectiveness of online education, self-management support and tele-monitoring in several domains of health and care. While new results gradually provide more evidence for eHealth's impact on quality issues, now is the time to come to grips with implementation issues. Documented drawbacks such as low acceptance, low adoption or low adherence need our attention today to make the most of eHealth' potential. Improvement science is beginning to deliver the tools to address these persistent behavioural and cultural issues. The ceHRes Roadmap, for instance, is a plural and pragmatic approach that includes users' needs. It is now imperative to improve our implementation strategies in order to scale up eHealth technologies. This will accelerate the much needed transformation of our healthcare systems and sustain access, affordability and quality for all in the near future.
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Affiliation(s)
- Hans C Ossebaard
- National Health Care Institute - Health Care Quality Institute, Eekholt 4, PO Box 320, 1110 AH, 1112 XH Diemen, The Netherlands Department of Psychology, Health & Technology, Centre for eHealth and Wellbeing Research, University of Twente, Drienerlolaan 5, PO Box 217, 7500AE, 7522 NB Enschede, The Netherlands
| | - Lisette Van Gemert-Pijnen
- Department of Psychology, Health & Technology, Centre for eHealth and Wellbeing Research, University of Twente, Drienerlolaan 5, PO Box 217, 7500AE, 7522 NB Enschede, The Netherlands
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O'Sullivan D, Wilk S, Kuziemsky C, Michalowski W, Farion K, Kukawka B. Is There a Consensus when Physicians Evaluate the Relevance of Retrieved Systematic Reviews? Methods Inf Med 2016; 55:292-8. [PMID: 26940845 DOI: 10.3414/me15-01-0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/07/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND A significant challenge associated with practicing evidence-based medicine is to provide physicians with relevant clinical information when it is needed. At the same time it appears that the notion of relevance is subjective and its perception is affected by a number of contextual factors. OBJECTIVES To assess to what extent physicians agree on the relevance of evidence in the form of systematic reviews for a common set of patient cases, and to identify possible contextual factors that influence their perception of relevance. METHODS A web-based survey was used where pediatric emergency physicians from multiple academic centers across Canada were asked to evaluate the relevance of systematic reviews retrieved automatically for 14 written case vignettes (paper patients). The vignettes were derived from prospective data describing pediatric patients with asthma exacerbations presenting at the emergency department. To limit the cognitive burden on respondents, the number of reviews associated with each vignette was limited to three. RESULTS Twenty-two academic emergency physicians with varying years of clinical practice completed the survey. There was no consensus in their evaluation of relevance of the retrieved reviews and physicians' assessments ranged from very relevant to irrelevant evidence, with the majority of evaluations being somewhere in the middle. This indicates that the study participants did not share a notion of relevance uniformly. Further analysis of commentaries provided by the physicians allowed identifying three possible contextual factors: expected specificity of evidence (acute vs chronic condition), the terminology used in the systematic reviews, and the micro environment of clinical setting. CONCLUSIONS There is no consensus among physicians with regards to what constitutes relevant clinical evidence for a given patient case. Subsequently, this finding suggests that evidence retrieval systems should allow for deep customization with regards to physician's preferences and contextual factors, including differences in the micro environment of each clinical setting.
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Affiliation(s)
| | - Szymon Wilk
- Szymon Wilk, Institute of Computing Science, Poznan University of Technology, Piotrowo 2, 60 - 965 Poznan, Poland, E-mail:
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Winter A, Hilgers RD, Hofestädt R, Hübner U, Knaup-Gregori P, Ose C, Schmoor C, Timmer A, Wege D. Good Medicine and Good Healthcare Demand Good Information (Systems). Methods Inf Med 2015; 54:385-7. [PMID: 26395286 DOI: 10.3414/me15-05-1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The demand for evidence-based health informatics and benchmarking of 'good' information systems in health care gives an opportunity to continue reporting on recent papers in the German journal GMS Medical Informatics, Biometry and Epidemiology (MIBE) here. The publications in focus deal with a comparison of benchmarking initiatives in German-speaking countries, use of communication standards in telemonitoring scenarios, the estimation of national cancer incidence rates and modifications of parametric tests. Furthermore papers in this issue of MIM are introduced which originally have been presented at the Annual Conference of the German Society of Medical Informatics, Biometry and Epidemiology. They deal as well with evidence and evaluation of 'good' information systems but also with data harmonization, surveillance in obstetrics, adaptive designs and parametrical testing in statistical analysis, patient registries and signal processing.
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Affiliation(s)
- A Winter
- Prof. Dr. Alfred Winter, Leipzig University, Institute for Medical Informatics, Statistics and Epidemiology, Haertelstr. 16 -18, 04107 Leipzig, Germany E-mail:
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Rigby M. Optimising Health Informatics Outcomes--Getting Good Evidence to Where it Matters. Methods Inf Med 2015; 54:295-7. [PMID: 26179640 DOI: 10.3414/me14-10-0139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 06/25/2015] [Indexed: 11/09/2022]
Abstract
This editorial is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Evidence-based Health informatics: How do we know what we know?", written by Elske Ammenwerth [1]. Health informatics uses and applications have crept up on health systems over half a century, starting as simple automation of large-scale calculations, but now manifesting in many cases as rule- and algorithm-based creation of composite clinical analyses and 'black box' computation of clinical aspects, as well as enablement of increasingly complex care delivery modes and consumer health access. In this process health informatics has very largely bypassed the rules of precaution, proof of effectiveness, and assessment of safety applicable to all other health sciences and clinical support systems. Evaluation of informatics applications, compilation and recognition of the importance of evidence, and normalisation of Evidence Based Health Informatics, are now long overdue on grounds of efficiency and safety. Ammenwerth has now produced a rigorous analysis of the current position on evidence, and evaluation as its lifeblood, which demands careful study then active promulgation. Decisions based on political aspirations, 'modernisation' hopes, and unsupported commercial claims must cease - poor decisions are wasteful and bad systems can kill. Evidence Based Health Informatics should be promoted, and expected by users, as rigorously as Cochrane promoted Effectiveness and Efficiency, and Sackett promoted Evidence Based Medicine - both of which also were introduced retrospectively to challenge the less robust and partially unsafe traditional 'wisdom' in vogue. Ammenwerth's analysis gives the necessary material to promote that mission.
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Affiliation(s)
- M Rigby
- Michael Rigby, Lavender Hill, 6 Carrighill Lower, Calverstown, Kilcullen, Co. Kildare, Ireland, E-mail:
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