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Mwogosi A, Shao D, Kibusi S, Kapologwe N. Revolutionizing decision support: a systematic literature review of contextual implementation models for electronic health records systems. J Health Organ Manag 2024; ahead-of-print. [PMID: 38704617 DOI: 10.1108/jhom-04-2023-0122] [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] [Indexed: 05/06/2024]
Abstract
PURPOSE This study aims to assess previously developed Electronic Health Records System (EHRS) implementation models and identify successful models for decision support. DESIGN/METHODOLOGY/APPROACH A systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources used were Scopus, PubMed and Google Scholar. The review identified peer-reviewed papers published in the English Language from January 2010 to April 2023, targeting well-defined implementation of EHRS with decision-support capabilities in healthcare. To comprehensively address the research question, we ensured that all potential sources of evidence were considered, and quantitative and qualitative studies reporting primary data and systematic review studies that directly addressed the research question were included in the review. By including these studies in our analysis, we aimed to provide a more thorough and reliable evaluation of the available evidence. FINDINGS The findings suggest that the success of EHRS implementation is determined by organizational and human factors rather than technical factors alone. Successful implementation is dependent on a suitable implementation framework and management of EHRS. The review identified the capabilities of Clinical Decision Support (CDS) tools as essential in the effectiveness of EHRS in supporting decision-making. ORIGINALITY/VALUE This study contributes to the existing literature on EHRS implementation models and identifies successful models for decision support. The findings can inform future implementations and guide decision-making in healthcare facilities.
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Affiliation(s)
- Augustino Mwogosi
- Department of Information Systems and Technology, College of Informatics and Virtual Education, The University of Dodoma, Dodoma City, United Republic of Tanzania
| | - Deo Shao
- Department of Information Systems and Technology, College of Informatics and Virtual Education, The University of Dodoma, Dodoma City, United Republic of Tanzania
| | - Stephen Kibusi
- Department of Public Health, The University of Dodoma, Dodoma City, United Republic of Tanzania
| | - Ntuli Kapologwe
- United Republic of Tanzania President's Office, Dar es Salaam, United Republic of Tanzania
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Jung SY, Lee K, Hwang H. Recent trends of healthcare information and communication technologies in pediatrics: a systematic review. Clin Exp Pediatr 2022; 65:291-299. [PMID: 34922424 PMCID: PMC9171461 DOI: 10.3345/cep.2020.01333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/02/2021] [Indexed: 11/27/2022] Open
Abstract
As information communication technology (ICT) has advanced, the healthcare industry has embraced it to reduce medical costs, improve health outcomes, and increase patient satisfaction. Healthcare ICT revolutionizes pediatric healthcare. This study aimed to categorize and synthesize findings from the literature regarding the application of ICT in pediatric patients. This systematic review is based on a comprehensive search of Embase, MEDLINE, and Google Scholar. Study selection and coding were performed independently by 2 researchers, followed by narrative categorization. To reflect current trends in ICT for pediatrics, we adopted the Hype cycle technology classification developed by the advisory and information technology firm, Gartner, and the classification of digital health interventions by the World Health Organization. This study included a total of 135 studies. The analysis revealed 7 main types of ICT for pediatrics: (1) telehealth (39 papers), (2) precision medicine (2 papers), (3) automated decision support systems (17 papers), (4) electronic health records (7 papers), (5) patient portals (7 papers), (6) artificial intelligence (AI) (39 papers), and (7) mobile and wearable technologies (20 papers). In particular, we consistently found references to ICT for pediatrics as well as changing and improving healthcare for children. Further studies are required to determine how we can improve ICT productivity for pediatrics, particularly through AI. This study's results will help healthcare delivery organizations and technology companies consider the future direction of pediatric healthcare.
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Affiliation(s)
- Se Young Jung
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keehyuck Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Hwang
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
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Tummers J, Tobi H, Catal C, Tekinerdogan B. Designing a reference architecture for health information systems. BMC Med Inform Decis Mak 2021; 21:210. [PMID: 34238281 PMCID: PMC8263849 DOI: 10.1186/s12911-021-01570-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Healthcare relies on health information systems (HISs) to support the care and receive reimbursement for the care provided. Healthcare providers experience many problems with their HISs due to improper architecture design. To support the design of a proper HIS architecture, a reference architecture (RA) can be used that meets the various stakeholder concerns of HISs. Therefore, the objective of this study is to develop and analyze an RA following well-established architecture design methods. Methods Domain analysis was performed to scope and model the domain of HISs. For the architecture design, we applied the views and beyond approach and designed the RA’s views based on the stakeholders and features from the domain analysis. We evaluated the RA with a case study. Results We derived the following four architecture views for HISs: The context diagram, decomposition view, layered view, and deployment view. Each view shows the architecture of the HIS from a different angle, suitable for various stakeholders. Based on a Japanese hospital information system study, we applied the RA and derived the application architecture. Conclusion We demonstrated that the methods of the software architecture design community could be used in the healthcare domain effectively and showed the applicability of the RA. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01570-2.
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Affiliation(s)
- Joep Tummers
- Information technology, Wageningen University & Research, Hollandseweg 1, 6701KN, Wageningen, The Netherlands.
| | - Hilde Tobi
- Biometris, Wageningen University & Research, Droevendaalsesteeg 1, 6706OB, Wageningen, The Netherlands
| | - Cagatay Catal
- Department of Computer Science and Engineering, Qatar University, 2713, Doha, Qatar
| | - Bedir Tekinerdogan
- Information technology, Wageningen University & Research, Hollandseweg 1, 6701KN, Wageningen, The Netherlands
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Lee Y, Bahn S, Shin GW, Jung MY, Park T, Cho I, Lee JH. Development of safety and usability guideline for clinical information system. Medicine (Baltimore) 2021; 100:e25276. [PMID: 33787612 PMCID: PMC8021279 DOI: 10.1097/md.0000000000025276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/03/2021] [Indexed: 01/04/2023] Open
Abstract
Clinical information systems (CISs) that do not consider usability and safety could lead to harmful events. Therefore, we aimed to develop a safety and usability guideline of CISs that is comprehensive for both users and developers. And the guideline was categorized to apply actual clinical workflow and work environment.The guideline components were extracted through a systematic review of the articles published between 2000 and 2015, and existing CIS safety and/or usability design guidelines. The guideline components were categorized according to clinical workflow and types of user interface (UI). The contents of the guideline were evaluated and validated by experts with 3 specialties: medical informatics, patient safety, and human engineering.Total 1276 guideline components were extracted through article and guideline review. Of these, 464 guideline components were categorized according to 5 divisions of the clinical workflow: "Data identification and selection," "Document entry," "Order entry," "Clinical decision support and alert," and "Management". While 521 guideline components were categorized according to 4 divisions of UI: UIs related to information process steps, "Perception," "Recognition," "Control," and "Feedback". We developed a guideline draft with 219 detailed guidance for clinical task and 70 for UI. Overall appropriateness and comprehensiveness were proven to achieve more than 90% in experts' survey. However, there were significant differences among the groups of specialties in the judgment of appropriateness (P < .001) and comprehensiveness (P = .038).We developed and verified a safety and usability guideline for CIS that qualifies the requirements of both clinical workflows and usability issues. The developed guideline can be a practical tool to enhance the usability and safety of CISs. Further validation is required by applying the guideline for designing the actual CIS.
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Affiliation(s)
- Yura Lee
- Department of Information Medicine, Asan Medical Center, Seoul
| | - Sangwoo Bahn
- Industrial and Management System Engineering, Kyung Hee University, Yongin
| | - Gee Won Shin
- Department of Industrial Engineering & Institute for Industrial Systems Innovation, Seoul National University
| | - Min-Young Jung
- Department of Information Medicine, Asan Medical Center, Seoul
| | - Taezoon Park
- Department of Industrial & Information Systems Engineering, Soongsil University, Seoul
| | - Insook Cho
- Nursing Department, Inha University, Incheon
| | - Jae-Ho Lee
- Department of Information Medicine, Asan Medical Center, Seoul
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Jo YY, Han J, Park HW, Jung H, Lee JD, Jung J, Cha HS, Sohn DK, Hwangbo Y. Prediction of Prolonged Length of Hospital Stay After Cancer Surgery Using Machine Learning on Electronic Health Records: Retrospective Cross-sectional Study. JMIR Med Inform 2021; 9:e23147. [PMID: 33616544 PMCID: PMC7939945 DOI: 10.2196/23147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/06/2021] [Accepted: 01/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Postoperative length of stay is a key indicator in the management of medical resources and an indirect predictor of the incidence of surgical complications and the degree of recovery of the patient after cancer surgery. Recently, machine learning has been used to predict complex medical outcomes, such as prolonged length of hospital stay, using extensive medical information. OBJECTIVE The objective of this study was to develop a prediction model for prolonged length of stay after cancer surgery using a machine learning approach. METHODS In our retrospective study, electronic health records (EHRs) from 42,751 patients who underwent primary surgery for 17 types of cancer between January 1, 2000, and December 31, 2017, were sourced from a single cancer center. The EHRs included numerous variables such as surgical factors, cancer factors, underlying diseases, functional laboratory assessments, general assessments, medications, and social factors. To predict prolonged length of stay after cancer surgery, we employed extreme gradient boosting classifier, multilayer perceptron, and logistic regression models. Prolonged postoperative length of stay for cancer was defined as bed-days of the group of patients who accounted for the top 50% of the distribution of bed-days by cancer type. RESULTS In the prediction of prolonged length of stay after cancer surgery, extreme gradient boosting classifier models demonstrated excellent performance for kidney and bladder cancer surgeries (area under the receiver operating characteristic curve [AUC] >0.85). A moderate performance (AUC 0.70-0.85) was observed for stomach, breast, colon, thyroid, prostate, cervix uteri, corpus uteri, and oral cancers. For stomach, breast, colon, thyroid, and lung cancers, with more than 4000 cases each, the extreme gradient boosting classifier model showed slightly better performance than the logistic regression model, although the logistic regression model also performed adequately. We identified risk variables for the prediction of prolonged postoperative length of stay for each type of cancer, and the importance of the variables differed depending on the cancer type. After we added operative time to the models trained on preoperative factors, the models generally outperformed the corresponding models using only preoperative variables. CONCLUSIONS A machine learning approach using EHRs may improve the prediction of prolonged length of hospital stay after primary cancer surgery. This algorithm may help to provide a more effective allocation of medical resources in cancer surgery.
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Affiliation(s)
- Yong-Yeon Jo
- Healthcare AI Team, National Cancer Center, Goyang, Republic of Korea
| | - JaiHong Han
- Department of Surgery, National Cancer Center, Goyang, Republic of Korea
| | - Hyun Woo Park
- Healthcare AI Team, National Cancer Center, Goyang, Republic of Korea
| | - Hyojung Jung
- Healthcare AI Team, National Cancer Center, Goyang, Republic of Korea
| | - Jae Dong Lee
- Healthcare AI Team, National Cancer Center, Goyang, Republic of Korea
| | - Jipmin Jung
- Cancer Data Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Hyo Soung Cha
- Cancer Data Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Yul Hwangbo
- Healthcare AI Team, National Cancer Center, Goyang, Republic of Korea
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Patel S, Boulton KA, Redoblado-Hodge MA, Papanicolaou A, Barnett D, Bennett B, Drevensek S, Cramsie J, Ganesalingam K, Ong N, Rozsa M, Sutherland R, Williamsz M, Pokorski I, Song YJC, Silove N, Guastella AJ. The Acceptability and Efficacy of Electronic Data Collection in a Hospital Neurodevelopmental Clinic: Pilot Questionnaire Study. JMIR Form Res 2021; 5:e18214. [PMID: 33464217 PMCID: PMC7854031 DOI: 10.2196/18214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 10/13/2020] [Accepted: 11/04/2020] [Indexed: 01/30/2023] Open
Abstract
Background There is a growing need for cost-efficient and patient-centered approaches to support families in hospital- and community-based neurodevelopmental services. For such purposes, electronic data collection (EDC) may hold advantages over paper-based data collection. Such EDC approaches enable automated data collection for scoring and interpretation, saving time for clinicians and services and promoting more efficient service delivery. Objective This pilot study evaluated the efficacy of EDC for the Child Development Unit, a hospital-based diagnostic assessment clinic in the Sydney Children’s Hospital Network. Caregiver response rates and preference for EDC or paper-based methods were evaluated as well as the moderating role of demographic characteristics such as age, level of education, and ethnic background. Methods Families were sent either a paper-based questionnaire via post or an electronic mail link for completion before attending their first on-site clinic appointment for assessment. A total of 62 families were provided a paper version of the questionnaire, while 184 families were provided the online version of the same questionnaire. Results Completion rates of the questionnaire before the first appointment were significantly higher for EDC (164/184, 89.1%) in comparison to paper-based methods (24/62, 39%; P<.001). Within the EDC group, a vast majority of respondents indicated a preference for completing the questionnaire online (151/173, 87.3%), compared to paper completion (22/173, 12.7%; P<.001). Of the caregiver demographic characteristics, only the respondent’s level of education was associated with modality preference, such that those with a higher level of education reported a greater preference for EDC (P=.04). Conclusions These results show that EDC is feasible in hospital-based clinics and has the potential to offer substantial benefits in terms of centralized data collation, time and cost savings, efficiency of service, and resource allocation. The results of this study therefore support the continued use of electronic methods to improve family-centered care in clinical practices.
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Affiliation(s)
- Shrujna Patel
- Autism Clinic for Translational Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kelsie Ann Boulton
- Autism Clinic for Translational Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Marie Antoinette Redoblado-Hodge
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Child Development Unit, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, Australia
| | - Angela Papanicolaou
- Child Development Unit, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, Australia
| | - Diana Barnett
- Child Development Unit, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, Australia
| | - Beverley Bennett
- Child Development Unit, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, Australia
| | - Suzi Drevensek
- Child Development Unit, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, Australia
| | - Jane Cramsie
- Child Development Unit, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, Australia
| | - Kalaichelvi Ganesalingam
- Child Development Unit, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, Australia
| | - Natalie Ong
- Child Development Unit, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, Australia
| | - Magdalen Rozsa
- Child Development Unit, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, Australia
| | - Rebecca Sutherland
- Child Development Unit, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, Australia
| | - Marcia Williamsz
- Child Development Unit, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, Australia
| | - Izabella Pokorski
- Autism Clinic for Translational Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Yun Ju Christine Song
- Autism Clinic for Translational Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Natalie Silove
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Child Development Unit, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, Australia
| | - Adam John Guastella
- Autism Clinic for Translational Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Park YT, Kim YS, Heo YJ, Lee JH, Chang H. Association of the Magnitude of Nurses With the Use of Health Information Exchanges: Analyzing the National Health Insurance Claim Data of Hospitals and Clinics in Korea. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211060788. [PMID: 34865552 PMCID: PMC8649911 DOI: 10.1177/00469580211060788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Many features of health care organizations (HCOs) have been identified to be associated with health information exchange (HIE), but subcategories of organizational factors focusing on nurse workforces still need to be identified. The objective of this study is to investigate the association of number of nurses with HIE use in Korea. METHODS This study had a retrospective study design and used health insurance claim data from June 1, 2016 to June 30, 2018. The unit of analysis was the HCO, and any health insurance claims having HIE were counted by HCO. There were a total of 1490 HCOs having any HIE and 24 026 HCOs not having HIE. For statistical analysis, two-part model was used: logistic regression for HIE participation and the generalized linear model for the volume of HIE use. RESULTS HIE was used by 44.6% of general hospitals, and 8.6% and 5.3% of small hospitals and clinics, respectively. Both HIE use and its volume were significantly positively associated with nurse variables. The use of HIE was significantly positively associated with nurse-to-bed ratio in general hospitals (OR 1.028; 1.016 to 1.041) and in small hospitals (OR 1.021; 1.016 to 1.027), and with the number of nurses (OR 1.041; 1.028 to 1.054) in clinics (P<.001). The volume of HIE use was also positively associated with nurse-to-bed ratio in general hospitals (OR 1.010; 1.004 to 1.017) and in small hospitals (OR 1.014; 1.006 to 1.022), and with the number of nurses (OR 1.055; 1.037 to 1.073) in clinics (P<.01). CONCLUSION This study found that there was a low rate of HIE use in small hospitals and clinics. The number of nurses was critically associated with the use of HIE and the volume of HIE claims. HIE policy makers need to be aware of this factor in seeking to accelerate HIE.
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Affiliation(s)
- Young-Taek Park
- HIRA Research Institute, Health Insurance Review and Assessment Service (HIRA), Wonju, Korea
- Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yeon Sook Kim
- Department of Nursing, California State University, San Bernardino, CA, USA
| | - Yun-Jung Heo
- Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Ho Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyejung Chang
- School of Management, Kyung Hee University, Seoul, Korea
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Jung SY, Lee K, Lee HY, Hwang H. Barriers and facilitators to implementation of nationwide electronic health records in the Russian Far East: A qualitative analysis. Int J Med Inform 2020; 143:104244. [PMID: 32942224 PMCID: PMC7396132 DOI: 10.1016/j.ijmedinf.2020.104244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Electronic health records (EHRs) are transforming and revolutionizing the healthcare industry. However, whereas developed countries have a high EHR penetration rate, adoption of EHRs in developing countries is lagging behind. Recently, the Korean and Russian governments have been pursuing economic cooperation in the Russian Far East. Thus, since 2009, Russia's EHR market and healthcare system have been maturing in tandem. OBJECTIVE To qualitatively investigate and analyze the current status of EHRs in the Russian Far East and derive implementation plans for nationwide EHRs. METHODS A qualitative analysis based on semi-structured interviews with healthcare professionals and administrative officers in the Russian Far East was conducted to illuminate the current status of EHRs and to collect various perspectives on barriers and facilitators to implementation. RESULTS The analysis revealed six major barriers and five major facilitators for implementation of nationwide EHRs in the Russian Far East. The barriers include lack of communications, an insufficient system development environment, poor adoption of standard terminology, poor infrastructure, resistance to a new system, and poor functionality. Facilitators include strategic government planning, centrally managed systems, health information exchange, willingness to use new functions, and well-established work processes. CONCLUSIONS This study's results, along with the experiences of developed countries that have already successfully introduced EHRs, will help support successful introduction of EHRs in the Russian Far East.
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Affiliation(s)
- Se Young Jung
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Keehyuck Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ho-Young Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
| | - Hee Hwang
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Jung SY, Hwang H, Lee K, Lee HY, Kim E, Kim M, Cho IY. Barriers and Facilitators to Implementation of Medication Decision Support Systems in Electronic Medical Records: Mixed Methods Approach Based on Structural Equation Modeling and Qualitative Analysis. JMIR Med Inform 2020; 8:e18758. [PMID: 32706717 PMCID: PMC7407246 DOI: 10.2196/18758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/02/2020] [Accepted: 05/14/2020] [Indexed: 01/23/2023] Open
Abstract
Background Adverse drug events (ADEs) resulting from medication error are some of the most common causes of iatrogenic injuries in hospitals. With the appropriate use of medication, ADEs can be prevented and ameliorated. Efforts to reduce medication errors and prevent ADEs have been made by implementing a medication decision support system (MDSS) in electronic health records (EHRs). However, physicians tend to override most MDSS alerts. Objective In order to improve MDSS functionality, we must understand what factors users consider essential for the successful implementation of an MDSS into their clinical setting. This study followed the implementation process for an MDSS within a comprehensive EHR system and analyzed the relevant barriers and facilitators. Methods A mixed research methodology was adopted. Data from a structured survey and 15 in-depth interviews were integrated. Structural equation modeling was conducted for quantitative analysis of factors related to user adoption of MDSS. Qualitative analysis based on semistructured interviews with physicians was conducted to collect various opinions on MDSS implementation. Results Quantitative analysis revealed that physicians’ expectations regarding ease of use and performance improvement are crucial. Qualitative analysis identified four significant barriers to MDSS implementation: alert fatigue, lack of accuracy, poor user interface design, and lack of customizability. Conclusions This study revealed barriers and facilitators to the implementation of MDSS. The findings can be applied to upgrade MDSS in the future.
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Affiliation(s)
- Se Young Jung
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Hwang
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keehyuck Lee
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ho-Young Lee
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eunhye Kim
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Miyoung Kim
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In Young Cho
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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10
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Villumsen S, Adler-Milstein J, Nøhr C. National monitoring and evaluation of eHealth: a scoping review. JAMIA Open 2020; 3:132-140. [PMID: 32607495 PMCID: PMC7309231 DOI: 10.1093/jamiaopen/ooz071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/13/2019] [Accepted: 12/22/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE There has been substantial growth in eHealth over the past decade, driven by expectations of improved healthcare system performance. Despite substantial eHealth investment, little is known about the monitoring and evaluation strategies for gauging progress in eHealth availability and use. This scoping review aims to map the existing literature and depict the predominant approaches and methodological recommendations to national and regional monitoring and evaluation of eHealth availability and use, to advance national strategies for monitoring and evaluating eHealth. METHODS Peer-reviewed and grey literature on monitoring and evaluation of eHealth availability and use published between January 1, 2009, and March 11, 2019, were eligible for inclusion. A total of 2354 publications were identified and 36 publications were included after full-text review. Data on publication type (eg, empirical research), country, level (national or regional), publication year, method (eg, survey), and domain (eg, provider-centric electronic record) were charted. RESULTS The majority of publications monitored availability alone or applied a combination of availability and use measures. Surveys were the most common data collection method (used in 86% of the publications). Organization for Economic Co-operation and Development (OECD), European Commission, Canada Health Infoway, and World Health Organization (WHO) have developed comprehensive eHealth monitoring and evaluation methodology recommendations. DISCUSSION Establishing continuous national eHealth monitoring and evaluation, based on international approaches and recommendations, could improve the ability for cross-country benchmarking and learning. This scoping review provides an overview of the predominant approaches to and recommendations for national and regional monitoring and evaluation of eHealth. It thereby provides a starting point for developing national eHealth monitoring strategies.
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Affiliation(s)
- Sidsel Villumsen
- Center for Health Informatics and Technology, Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research, School of Medicine, University of California, San Francisco, California, USA
| | - Christian Nøhr
- Center for Health Informatics and Technology, Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
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11
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Park YT, Kim D, Park RW, Atalag K, Kwon IH, Yoon D, Choi M. Association between Full Electronic Medical Record System Adoption and Drug Use: Antibiotics and Polypharmacy. Healthc Inform Res 2020; 26:68-77. [PMID: 32082702 PMCID: PMC7010944 DOI: 10.4258/hir.2020.26.1.68] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/29/2019] [Accepted: 01/20/2020] [Indexed: 01/21/2023] Open
Abstract
Objectives We investigated associations between full Electronic Medical Record (EMR) system adoption and drug use in healthcare organizations (HCOs) to explore whether EMR system features such as electronic prescribing, medicines reconciliation, and decision support, might be related to drug use by using the relevant nation-wide data. Methods The study design was cross-sectional. Survey data of the level of adoption of EMR systems were collected for the Organization for Economic Co-operation and Development benchmarking information and communication technologies (ICT) study between November 2013 and January 2014, in Korea. Survey respondents were hospital chief information officers and medical practitioners in primary care clinics. From the national health insurance administrative dataset, two outcomes, the rate of antibiotic prescription and polypharmacy with ≥6 drugs, were extracted. Results We found that full EMR adoption showed a 16.1% lower antibiotic drug prescription than partial adoption including paper-based medical charts in the hospital only (p = 0.041). Between EMR adoption status and polypharmacy prescription, only those clinics which fully adopted EMR showed significant associations with higher polypharmacy prescriptions (36.9%, p = 0.001). Conclusions The findings suggested that there might be some confounding effects present and sophisticated ICT may provide some benefits to the quality of care even with some mixed results. Although a negative relationship between full EMR system adoption and antibiotic drug use was only significant in hospitals, EMR system functions searching drugs or listing specific patients might facilitate antibiotic drug use reduction. Positive relationships between full EMR system adoption and polypharmacy rate in general hospitals and clinics, but not hospitals, require further research.
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Affiliation(s)
- Young-Taek Park
- Department of Information and Communication Technology, Health Insurance Review and Assessment Service, Wonju, Korea
| | - Donghwan Kim
- Research Institute for Health Insurance Review and Assessment, Health Insurance Review and Assessment Service, Wonju, Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Koray Atalag
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - In Ho Kwon
- Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Dukyong Yoon
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Mona Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
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12
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Assessing How Well Electronic Nursing Records Reflect Changes in the Nursing Profession's Scope of Practice in Korea. Comput Inform Nurs 2020; 38:312-319. [PMID: 31913862 DOI: 10.1097/cin.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Electronic health records, a source of key administrative data for patient care, have been used in Korea for the past 13 years. In recent years, there have been significant changes in the Korean hospital nursing care delivery system. "Comprehensive nursing service," in which nurses provide direct care to patients, including activities of daily living without a family member, is one of the changes in the nursing profession's scope of practice. Accordingly, this study attempts to determine how well the electronic nursing record reveals nursing services that are being used differently. This study analyzed 19 372 nursing records of a total of 200 patients using the random sampling method in two comprehensive nursing service wards and two noncomprehensive nursing service wards. The number of nursing activity records for all items in the comprehensive nursing service ward was higher; only three items showed significant differences. Five nursing diagnoses including "anxiety" and "pain" were more significantly used in the records of the comprehensive nursing service ward. This study found that there were significant differences in nursing records based on the nursing services provided and that the current electronic nursing recording system adequately reflects changes in nursing practice.
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13
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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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14
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Kim SK, Oh Y, Nam S. Research trends in Korean medicine based on temporal and network analysis. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:160. [PMID: 31277641 PMCID: PMC6612192 DOI: 10.1186/s12906-019-2562-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 06/12/2019] [Indexed: 12/28/2022]
Abstract
Background Much research on Korean medicine has been recently published in Korea. The aim of this study was to determine the research trends in Korean medicine by performing a comprehensive analysis of articles that have been published in Korea using temporal and network analysis methods. Methods A total of 29,876 articles from 1963 to 2018 were prepared from OASIS (Oriental Medicine Advanced Searching Integrated System), the largest portal for Korean medicine. After the keywords and years were extracted from the metadata of the articles, an annual frequency matrix was obtained for the keywords. By using the matrix, the temporal trends of the keywords were analyzed by comparing the changes in similarity between the lists of keywords by year. Moreover, to analyze the relationship among research topics, a clustered network was constructed in which a node was a keyword and an edge was a similarity between two keywords. Results The temporal trend of the keywords was classified into six chronological phases. The appearance frequency of most keywords tended to increase gradually, but only the keywords “mibyeong,” “systems biology” and “korean medicine hospital” appeared in the most recent phase. The network of keywords was clustered and visualized into thirteen groups with the Gephi software. The main keywords in each group were related to effects such as “anti-inflammation” and “antioxidant,” to diseases such as “allergic rhinitis” and “diabetes” and to therapies such as “herbal acupuncture” and “herbal formula.” Conclusions The analysis of the trends determined in this study provides a systematic understanding as well as future research directions in Korean medicine to researchers. In the future, an overall analysis of the research trends in Korean medicine will be done by analyzing articles published in Korea and other countries. Electronic supplementary material The online version of this article (10.1186/s12906-019-2562-0) contains supplementary material, which is available to authorized users.
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15
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Park YT, Kim YS, Yi BK, Kim SM. Clinical Decision Support Functions and Digitalization of Clinical Documents of Electronic Medical Record Systems. Healthc Inform Res 2019; 25:115-123. [PMID: 31131146 PMCID: PMC6517626 DOI: 10.4258/hir.2019.25.2.115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives The objective of this study was to investigate the clinical decision support (CDS) functions and digitalization of clinical documents of Electronic Medical Record (EMR) systems in Korea. This exploratory study was conducted focusing on current status of EMR systems. Methods This study used a nationwide survey on EMR systems conducted from July 25, 2018 to September 30, 2018 in Korea. The unit of analysis was hospitals. Respondents of the survey were mainly medical recorders or staff members in departments of health insurance claims or information technology. This study analyzed data acquired from 132 hospitals that participated in the survey. Results This study found that approximately 80% of clinical documents were digitalized in both general and small hospitals. The percentages of general and small hospitals with 100% paperless medical charts were 33.7% and 38.2%, respectively. The EMR systems of general hospitals are more likely to have CDS functions of warnings regarding drug dosage, reminders of clinical schedules, and clinical guidelines compared to those of small hospitals; this difference was statistically significant. For the lists of digitalized clinical documents, almost 93% of EMR systems in general hospitals have the inpatient progress note, operation records, and discharge summary notes digitalized. Conclusions EMRs are becoming increasingly important. This study found that the functions and digital documentation of EMR systems still have a large gap, which should be improved and made more sophisticated. We hope that the results of this study will contribute to the development of more sophisticated EMR systems.
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Affiliation(s)
- Young-Taek Park
- Research Institute for Health Insurance Claims Review & Assessment, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Yeon Sook Kim
- Department of Nursing, California State University, San Bernardino, CA, USA
| | - Byoung-Kee Yi
- Smart Healthcare & Device Research Center, Samsung Medical Center, Seoul, Korea.,Samsung Advanced Institute of Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Sang Mi Kim
- Department of Big Data Analytics, Ewha Womans University, Seoul, Korea
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16
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Tang S, Ghose B, Hoque MR, Hao G, Yaya S. Women Using Mobile Phones for Health Communication Are More Likely to Use Prenatal and Postnatal Services in Bangladesh: Cross-Sectional Study. JMIR Mhealth Uhealth 2019; 7:e10645. [PMID: 30816850 PMCID: PMC6416540 DOI: 10.2196/10645] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/17/2018] [Accepted: 10/22/2018] [Indexed: 11/21/2022] Open
Abstract
Background The public health system in Bangladesh has been struggling to provide coverage and utilization of basic maternal health care services in pursuit of achieving maternal and child mortality-related goals. Interestingly, the rapid popularization of mobile technology in the country is transforming the landscape of health care access and delivery. However, little is known regarding the use of mobile phones from the perspective of maternal health care service utilization. Objective In this study, we aimed to investigate the prevalence and sociodemographic pattern of mobile phone use for health services among women and relationship between the use of mobile phone use and the uptake of essential maternal health services (MHSs). Methods Cross-sectional data from the Bangladesh Demographic and Health Survey on 4494 mothers aged between 15 and 39 years were used in the analysis. Using mobile phones to get health services or advice was hypothesized to have a positive association with the uptake of basic MHSs (antenatal care, ANC, facility delivery services, postnatal care) and postnatal care for the newborn. Data were analyzed using bivariate and multivariable techniques. Results More than a quarter (1276/4494, 28.4%; 95% CI 26.8-30.3) of the women aged 15-39 years reported using mobile phones to get health services with significant sociodemographic variations in the use of mobile phones. Analysis of the specific purposes revealed that, in most cases, mobile phones were used to contact service providers and consult with the same about what to do, whereas a smaller proportion reported using mobile phone for the purposes of arranging money and transportation. Multivariable analysis showed that compared with respondents who reported not using mobile phones for health care services, those who used them had higher odds of making 3+ ANC visits and delivering at a health facility. The odds were slightly higher for rural residents than for those in the urban areas. Conclusions The findings of this study conclude that women who use mobile phones are more likely to use ANC and professional delivery services than those who do not. More in-depth studies are necessary to understand the mechanism through which mobile phone-based services enhance the uptake of maternal health care.
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Affiliation(s)
- Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bishwajit Ghose
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Md Rakibul Hoque
- Department of Management Information Systems, Faculty of Business Studies, University of Dhaka, Dhaka, Bangladesh
| | - Gang Hao
- Zunyi Medical and Pharmaceutical College, Guizhou, China
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
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17
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Lee JJ, Carson MN, Clarke CL, Yang SC, Nam SJ. Nursing students' learning dynamics with clinical information and communication technology: A constructive grounded theory approach. NURSE EDUCATION TODAY 2019; 73:41-47. [PMID: 30502593 DOI: 10.1016/j.nedt.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 10/09/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The learning of nursing students can be facilitated through direct and/or indirect experiences of using clinical information and communication technology during clinical placements. However, nursing students experience difficulties in using technology for learning. Despite the difficulties, nursing students' learning dynamics with technology in real clinical contexts is poorly understood. OBJECTIVES To develop a theoretical model by identifying nursing students' learning dynamics with clinical information and communication technology and the factors influencing the dynamics. DESIGN A constructivist grounded theory approach was employed in order to develop the theoretical model. SETTINGS This research was conducted by recruiting nursing students from four universities in Seoul, South Korea. PARTICIPANTS Sixteen fourth year nursing students were recruited by purposive sampling. METHODS This research collected qualitative interview data in up to four rounds of interviews using open-ended and semi-structured interview questions. A total of 23 interviews were conducted. The data were transcribed verbatim. All interview data were analysed using three coding methods; initial, focused, and theoretical coding. NVivo 11 was used for data management. RESULTS This research developed a theoretical model of nursing students' learning dynamics with clinical information and communication technology. The model explains three dynamics that influence nursing students' use of clinical information and communication technology (interpersonal, organisational and emotional dynamics) and the students' responses regarding the dynamics for learning in clinical contexts. CONCLUSIONS Nursing educators can use the theoretical model to understand how best to support nursing students in navigating their clinical environments to build competency in using clinical information and communication technology.
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Affiliation(s)
- Jung Jae Lee
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Maggie N Carson
- School of Health in Social Science, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Charlotte L Clarke
- School of Health in Social Science, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Sook Ching Yang
- Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | - Su Jin Nam
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
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18
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Lee YT, Park YT, Park JS, Yi BK. Association between Electronic Medical Record System Adoption and Healthcare Information Technology Infrastructure. Healthc Inform Res 2018; 24:327-334. [PMID: 30443421 PMCID: PMC6230536 DOI: 10.4258/hir.2018.24.4.327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/21/2018] [Accepted: 10/21/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives The objective of this study was to investigate the relationship between the level of Electronic Medical Record (EMR) system adoption and healthcare information technology (IT) infrastructure. Methods Both survey and various healthcare administrative datasets in Korea were used. The survey was conducted during the period from June 13 to September 25, 2017. The chief information officers of hospitals were respondents. Among them, 257 general hospitals and 273 small hospitals were analyzed. A logistic regression analysis was conducted using the SAS program. Results The odds of having full EMR systems in general hospitals statistically significantly increased as the number of IT department staff members increased (odds ratio [OR] = 1.058, confidence interval [CI], 1.003–1.115; p = 0.038). The odds of having full EMR systems was significantly higher for small hospitals that had an IT department than those of small hospitals with no IT department (OR = 1.325; CI, 1.150–1.525; p < 0.001). Full EMR system adoption had a positive relationship with IT infrastructure in both general hospitals and small hospitals, which was statistically significant in small hospitals. The odds of having full EMR systems for small hospitals increased as IT infrastructure increased after controlling the covariates (OR = 1.527; CI, 1.317–4.135; p = 0.004). Conclusions This study verified that full EMR adoption was closely associated with IT infrastructure, such as organizational structure, human resources, and various IT subsystems. This finding suggests that political support related to these areas is indeed necessary for the fast dispersion of EMR systems into the healthcare industry.
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Affiliation(s)
- Youn-Tae Lee
- Bureau of Future Health Industry Policy, Korea Health Industry Development Institute, Cheongju, Korea
| | - Young-Taek Park
- Research Institute for Health Insurance Claims Review & Assessment, Health Insurance Review & Assessment Service (HIRA), Wonju, Korea
| | - Jae-Sung Park
- Department of Health Care Administration, Kosin University, Busan, Korea
| | - Byoung-Kee Yi
- Smart Healthcare & Device Research Center, Samsung Medical Center, Seoul, Korea.,Samsung Advanced Institute of Health Science and Technology, Sungkyunkwan University, Seoul, Korea
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19
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Regional differences in electronic medical record adoption in Japan: A nationwide longitudinal ecological study. Int J Med Inform 2018; 115:114-119. [PMID: 29779713 DOI: 10.1016/j.ijmedinf.2018.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Regional differences in the adoption of electronic medical records (EMR) are a major problem, yet little is known about these differences internationally. We analyzed regional differences in EMR adoption in Japan and evaluated factors associated with these differences. METHODS This nationwide ecological study used secondary data from all secondary medical service areas (SMSAs) in fiscal years 2008 (n = 348) and 2014 (n = 344). For each SMSA we collected the following information from a Japanese national database: the number of medical facilities that had adopted EMR, the population density, the average per capita income, the number of working doctors per 1000 people, and the proportion of interns to all working doctors. To adjust for medical facility characteristics in each SMSA, such as number of beds, public versus private hospital, and hospital type (psychiatric or other), we estimated the standardized adoption ratio (SAR) for EMR adoption, modeled on the standardized mortality ratio. We calculated Moran's I for the SAR and investigated whether the SAR had spatial autocorrelations. We evaluated the association between the SAR and regional factors with a conditional autoregressive model. We compared these results in 2008 and 2014, for both hospitals and clinics. RESULTS While the EMR adoption rate in SMSAs increased, Moran's I of the SAR in hospitals was close to 1 in both 2008 and 2014, and Moran's I of the SAR in clinics increased from 2008 to 2014. For hospitals, there was a significant association between the proportion of interns to all working doctors and the SAR only in 2008. For clinics, average income in the SMSA was positively associated with the SAR, whereas the number of working doctors was negatively associated with the SAR in both 2008 and 2014. Population density was positively associated with the SAR only in 2014. CONCLUSION From 2008 to 2014, EMR adoption in Japan generally increased, but geographical differences did not improve. Regional factors associated with the SAR were different for hospitals than for clinics. Therefore, the government should take different approaches for clinics and hospitals to improve regional differences in EMR adoption, especially in providing financial and technical support.
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Thu SWYM, Kijsanayotin B, Kaewkungwal J, Soonthornworasiri N, Pan-Ngum W. Satisfaction with Paper-Based Dental Records and Perception of Electronic Dental Records among Dental Professionals in Myanmar. Healthc Inform Res 2017; 23:304-313. [PMID: 29181240 PMCID: PMC5688030 DOI: 10.4258/hir.2017.23.4.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives To overcome challenges in the implementation of electronic dental record systems in a low-resource setting, it is crucial to know the level of users’ satisfaction with the existing system of paper-based dental records and their perceptions of electronic dental records. Methods A cross-sectional paper-based questionnaire survey was conducted among Myanmar dental professionals who worked in one of two teaching hospitals or in private dental clinics. Descriptive data were analyzed and regression analysis was carried out to identify factors influencing perceptions of electronic dental records. Results Most dental professionals (>60%) were satisfied with just three out of six aspects of paper-based dental records (familiarity, flexibility, and portability). In addition, generalized positive perceptions were found among decision makers towards electronic dental records, and 86% of dentists indicated that they were willing to use them. Financial concerns were identified as the most important barrier to the implementation of electronic dental records among dentists who were not willing to use the proposed system. Conclusions The first step towards implementing electronic dental records in Myanmar should be improvement of the content and structure of paper-based dental records, especially in private dental clinics. Utilization of appropriate open-source electronic dental record software in private dental clinics is recommended to address perceived issues around financial barriers. For the long term, we recommend providing further education and training in health informatics to healthcare professionals to facilitate the efficient use of electronic dental record software in Myanmar in the future.
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Affiliation(s)
- Sai Wai Yan Myint Thu
- Department of Tropical Hygiene (Biomedical and Health Informatics), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Jaranit Kaewkungwal
- Department of Tropical Hygiene (Biomedical and Health Informatics), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ngamphol Soonthornworasiri
- Department of Tropical Hygiene (Biomedical and Health Informatics), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wirichada Pan-Ngum
- Department of Tropical Hygiene (Biomedical and Health Informatics), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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