Development of a Knowledge Base for Chronic Wound Management Using the Decision Model & Notation

Chronic wounds have significant impacts on patient health-related quality of life (HRQoL) and the healthcare expenditures. Various complex decision-making scenarios arise from wound management. Clinical decision-making systems (CDSS) can assist in relieving healthcare providers in these complex decision-making processes and improve the quality of care. In our study, we used the Decision Model & Notation (DMN) standard as a knowledge representation format to implement a knowledge base for chronic wound material recommendation in phase-based therapy. The resulting decision model is theoretically consistent and sustainable. With this study, we also emphasized the need of a semantic interoperability framework. This opens further research possibilities regarding the improvement of the model and the interest of DMN for decision models in clinical fields.

Ontology-Based Personalized Cognitive Behavioural Plans for Patients with Mild Depression

Cognitive Behavioural Therapy (CBT) is an action-oriented psychotherapy that combines cognitive and behavioural techniques for psychosocial treatment for depression, and is considered by many to be the golden standard in psychotherapy. More recently, computerized CBT (CCBT) has been deployed to help increase availability and access to this evidence-based therapy. In this vein, a CBT ontology, as a shared common understanding of the domain, can facilitate the aggregation, verification, and operationalization of computerized CBT knowledge. Moreover, as opposed to black-box applications, ontology-enabled systems allow recommended, evidence-based treatment interventions to be traced back to the corresponding psychological concepts. We used a Knowledge Management approach to synthesize and computerize CBT knowledge from multiple sources into a CBT ontology, which allows generating personalized action plans for treating mild depression, using the Web Ontology Language (OWL) and Semantic Web Rule Language (SWRL). We performed a formative evaluation of the CBT ontology in terms of its completeness, consistency, and conciseness.

Managing Ideas, People, and Projects: Organizational Tools and Strategies for Researchers

Primary Investigators at all levels of their career face a range of challenges related to optimizing their activity within the constraints of deadlines and productive research. These range from enhancing creative thought and keeping track of ideas to organizing and prioritizing the activity of the members of the group. Numerous tools now exist that facilitate the storage and retrieval of information necessary for running a laboratory to advance specific project goals within associated timelines. Here we discuss strategies and tools/software that, together or individually, can be used as is or adapted to any size scientific laboratory. Specific software products, suggested use cases, and examples are shown across the life cycle from idea to publication. Strategies for managing the organization of, and access to, digital information and planning structures can greatly facilitate the efficiency and impact of an active scientific enterprise. The principles and workflow described here are applicable to many different fields.

A Knowledge-Based Platform for Assessing Potential Adverse Drug Reactions at the Point of Care: User Requirements and Design

Even though Adverse Drug Reactions (ADRs) constitute a significant public health issue, there is a lack of Information & Communication Technologies (ICT) tools supporting Pharmacovigilance activities at the point of care. In this paper, we present the rationale of a Web-based platform to address this need. The driving user scenario of the proposed platform refers to a clinician who investigates information for a possible ADR as part of a specific patient treatment. The goal is to facilitate this assessment through appropriate tools for searching various relevant data sources, analysing the acquired data, aggregating the obtained evidence, and offering follow-up ADR monitoring over time in a systematic and user-friendly way. In this regard, we describe the adopted user requirements engineering methodology and illustrate the use of Knowledge Engineering (KE) as the platform's main technical paradigm to enable heterogeneous data integration and handle the complexity of the underlying information processing workflow.

Appraisal of the methodological quality of clinical practice guidelines in the Philippines

PURPOSE

The Republic of the Philippines has recently enacted the Universal Health Care Law, which mandates the Philippines Department of Health (DOH) to operationalize evidence-based clinical practice guideline (CPG) development. As a baseline to the foregoing task, the aim of this study was to appraise the methodological quality of CPGs previously developed and currently being disseminated in the Philippines. A multimethod search for CPGs was implemented. CPGs were independently evaluated using a modified version of the Knowledge Management Plus CPG appraisal tool.

FINDINGS

Eighty-seven CPGs were included in the appraisal. Majority implemented processes to ensure validity, ie, consideration for patient groups, management options, benefits, and harms (99%), and indicated strength of their recommendations (89%). Seventy-seven CPGs (89%) evaluated the evidence for local applicability. Of the 87 CPGs, 20 CPGs (23%) considered equity in the development process. The development process differed among CPGs with varying degrees of utilization of GRADE methodology (52%), disclosure of funding sources (72%), and engagement of technical support external to the development body (3%). Mean duration of CPG development was 1 year (SD 5.9 months), and mean interval between updates was 6 years and 1 month (SD 37.8 months).

CONCLUSION

Although most of the CPGs fulfilled essential criteria for quality recommendations (validity and applicability), equity considerations were limited. Furthermore, only half used the GRADE approach and development and dissemination practices differed substantially between CPGs. Thus, it is recommended that a standard CPG development process be made available by the DOH to be utilized by CPG developers in the Philippines.

[To promote knowledge on patient safety: the case of the Biblioteca Breve de Seguridad del Paciente (Brief Patient Safety Library)]

OBJECTIVE

Within the framework of the Patient Safety Strategy 2015-2020, the Regional Ministry of Health of the Community of Madrid developed two lines of action to consolidate the Patient Safety Culture through the dissemination of scientific knowledge in Patient Safety. The main objective was to identify, disseminate and improve access to relevant information on patient safety for patient-citizens, professionals and the organization itself through a pool of resources accessible on the Internet and intranet.

METHODS

After an analysis of the tools and communication channels available to disseminate knowledge in patient safety, the references of interest were selected by a group of experts, a consultation tool was developed in a navigable format on the internet and various dissemination actions were carried out to make it known.

RESULTS

The Biblioteca Breve de Seguridad del Paciente (Brief Patient Safety Library) was developed, accessible for navigation on the web of the Community of Madrid and as a download document, with 154 references, structured in 4 areas: General resources (74 references), Resources by thematic area (51 references), Videos and multimedia (12 references) and Organizations and websites of interest (17 references).

CONCLUSIONS

The Biblioteca Breve de Seguridad del Paciente (Brief Patient Safety Library) can help to promote the safety culture in health centers and to achieve greater citizen involvement in their safety, by providing reliable information on this crosscutting dimension of clinical practice.

Design and Construction of a NLP Based Knowledge Extraction Methodology in the Medical Domain Applied to Clinical Information

Objectives

This research presents the design and development of a software architecture using natural language processing tools and the use of an ontology of knowledge as a knowledge base.

Methods

The software extracts, manages and represents the knowledge of a text in natural language. A corpus of more than 200 medical domain documents from the general medicine and palliative care areas was validated, demonstrating relevant knowledge elements for physicians.

Results

Indicators for precision, recall and F-measure were applied. An ontology was created called the knowledge elements of the medical domain to manipulate patient information, which can be read or accessed from any other software platform.

Conclusions

The developed software architecture extracts the medical knowledge of the clinical histories of patients from two different corpora. The architecture was validated using the metrics of information extraction systems.

Risk and Disaster Management: From Planning and Expertise to Smart, Intelligent, and Adaptive Systems

"Disaster" means some surprising and misfortunate event. Its definition is broad and relates to complex environments. Medical Informatics approaches, methodologies and systems are used as a part of Disaster and Emergency Management systems. At the Holon Institute of Technology - HIT, Israel, in 2016 a National R&D Center: AFRAN was established to study the disaster's reduction aspects. The Center's designation is to investigate and produce new approaches, methodologies and to offer recommendations in the fields of disaster mitigation, preparedness, response and recovery and to disseminate disaster's knowledge. Adjoint to the Center a "Smart, Intelligent, and Adaptive Systems" laboratory (SIAS) was established with the goal to study the applications of Information and Communication Technologies (ICT) and Artificial Intelligence (AI) to Risk and Disaster Management (RDM). In this paper, we are redefining the concept of Disaster, pointing-out how ICT, AI, in the Big Data era, are central players in the RDM game. In addition we show the merit of the Center and lab combination to the benefit of the performed research projects.

Architecture and Initial Development of a Knowledge-as-a-Service Activator for Computable Knowledge Objects for Health

The Knowledge Grid (KGrid) is a research and development program toward infrastructure capable of greatly decreasing latency between the publication of new biomedical knowledge and its widespread uptake into practice. KGrid comprises digital knowledge objects, an online Library to store them, and an Activator that uses them to provide Knowledge-as-a-Service (KaaS). KGrid's Activator enables computable biomedical knowledge, held in knowledge objects, to be rapidly deployed at Internet-scale in cloud computing environments for improved health. Here we present the Activator, its system architecture and primary functions.

Clinical Knowledge Governance Framework for Nationwide Data Infrastructure Projects

BACKGROUND

The availability of semantically-enriched and interoperable clinical information models is crucial for reusing once collected data across institutions like aspired in the German HiGHmed project. Funded by the Federal Ministry of Education and Research, this nationwide data infrastructure project adopts the openEHR approach for semantic modelling. Here, strong governance is required to define high-quality and reusable models.

OBJECTIVES

Design of a clinical knowledge governance framework for openEHR modelling in cross-institutional settings like HiGHmed.

METHODS

Analysis of successful practices from international projects, published ideas on archetype governance and own modelling experiences as well as modelling of BPMN processes.

RESULTS

We designed a framework by presenting archetype variations, roles and responsibilities, IT support and modelling workflows.

CONCLUSION

Our framework has great potential to make the openEHR modelling efforts manageable. Because practical experiences are rare, prospectively our work will be predestinated to evaluate the benefits of such structured governance approaches.

Special Topic Interoperability and EHR: Combining openEHR, SNOMED, IHE, and Continua as approaches to interoperability on national eHealth

OBJECTIVES

The main aims of the paper comprise the characterization and examination of the potential approaches regarding interoperability. This includes openEHR, SNOMED, IHE, and Continua as combined interoperability approaches, possibilities for their incorporation into the eHealth environment, and identification of the main success factors in the field, which are necessary for achieving required interoperability, and consequently, for the successful implementation of eHealth projects in general.

METHODS

The paper represents an in-depth analysis regarding the potential application of openEHR, SNOMED, IHE and Continua approaches in the development and implementation process of eHealth in Slovenia. The research method used is both exploratory and deductive in nature. The methodological framework is grounded on information retrieval with a special focus on research and charting of existing experience in the field, and sources, both electronic and written, which include interoperability concepts and related implementation issues.

RESULTS

The paper will try to answer the following inquiries that are complementing each other: 1. Scrutiny of the potential approaches, which could alleviate the pertinent interoperability issues in the Slovenian eHealth context. 2. Analyzing the possibilities (requirements) for their inclusion in the construction process for individual eHealth solutions. 3. Identification and charting the main success factors in the interoperability field that critically influence development and implementation of eHealth projects in an efficient manner.

CONCLUSIONS

Provided insights and identified success factors could serve as a constituent of the strategic starting points for continuous integration of interoperability principles into the healthcare domain. Moreover, the general implementation of the identified success factors could facilitate better penetration of ICT into the healthcare environment and enable the eHealth-based transformation of the health system especially in the countries which are still in an early phase of eHealth planning and development and are often confronted with differing interests, requirements, and contending strategies.

Architecture and Initial Development of a Digital Library Platform for Computable Knowledge Objects for Health

Throughout the world, biomedical knowledge is routinely generated and shared through primary and secondary scientific publications. However, there is too much latency between publication of knowledge and its routine use in practice. To address this latency, what is actionable in scientific publications can be encoded to make it computable. We have created a purpose-built digital library platform to hold, manage, and share actionable, computable knowledge for health called the Knowledge Grid Library. Here we present it with its system architecture.

A Digital Framework to Support Providers and Patients in Diabetes Related Behavior Modification

We present Diabetes Web-Centric Information and Support Environment (D-WISE) that features: (a) Decision support tool to assist family physicians to administer Behavior Modification (BM) strategies to patients; and (b) Patient BM application that offers BM strategies and motivational interventions to engage patients. We take a knowledge management approach, using semantic web technologies, to model the social cognition theory constructs, Canadian diabetes guidelines and BM protocols used locally, in terms of a BM ontology that drives the BM decision support to physicians and BM strategy adherence monitoring and messaging to patients. We present the qualitative analysis of D-WISE usability by both physicians and patients.

Green Turning Brown - Domain Engineering for Social and Health Services in Finland

Being able to design information systems to an untouched domain, without the burden of existing information systems, especially legacy systems, is often seen as a dream of most information system professionals. Uncharted domains are anyway scarce, and often such greenfield projects turn into brownfield projects, also to projects where existing structures severely constrain the development of new systems. In this article we discuss the concepts of greenfield and brownfield domain engineering and software development, and reflect their possible messages to the re-engineering of the Finnish health- and social care ecosystem currently under way. In our fieldwork we could identify a lot of need and wish for greenfield domain engineering in the Finnish health and social services delivery. As well we found a lot of brownfield elements inhibiting change. Our proposal for the future is a ecosystem approach, where new and established elements could live together in a self-governed balance.

Knowledge Management in Health Technology SMEs

The purpose of this study was to examine knowledge management's (KM) role in small and medium-sized (SMEs) health technology enterprises, which employ fewer than 250 employees. In this study, KM is understood as the ability to achieve competitive advantage by utilizing management knowledge and making it profitable. The health technology enterprises use modern technology to resolve health-related issues. The research data was acquired from Finnish health technology SMEs. The questionnaire was sent to 140 enterprises, generating 25 responses, or a 17.9% response rate. According to the results, health technology enterprises have not adopted KM concepts, nor do they have the necessary resources to do so. SMEs' KM use is informal: information is transferred informally through human interaction, rather than through information systems. In the SMEs, KM is not perceived as important, although it is seen as associated with the enterprise's financial performance through the potential in making the knowledge profitable.

Expressing Biomedical Ontologies in Natural Language for Expert Evaluation

We report on a study of our custom Hootation software for the purposes of assessing its ability to produce clear and accurate natural language phrases from axioms embedded in three biomedical ontologies. Using multiple domain experts and three discrete rating scales, we evaluated the tool on clarity of the natural language produced, fidelity of the natural language produced from the ontology to the axiom, and the fidelity of the domain knowledge represented by the axioms. Results show that Hootation provided relatively clear natural language equivalents for a select set of OWL axioms, although the clarity of statements hinges on the accuracy and representation of axioms in the ontology.

Investigating Knowledge Management Status among Faculty Members of Kerman University of Medical Sciences based on the Nonaka Model in 2015

INTRODUCTION

Education and research are two major functions of universities, which require proper and systematic exploitation of available knowledge and information. Therefore, it is necessary to investigate the knowledge management status in an education system by considering the function of faculty members in creation and dissemination of knowledge. This study was conducted to investigate the knowledge management status among faculty members of the Kerman University of Medical Sciences based on the Nonaka and Takeuchi models in 2015.

METHODS

This was a descriptive-analytical and cross-sectional study. It was conducted on 165 faculty members at the Kerman University of Medical Sciences, who were selected from seven faculties as weighted using a random stratified sampling method. The Nonaka and Takeuchi knowledge management questionnaire consists of 26 questions in four dimensions of socialization, externalization, internalization, and combination. Scoring of questions was conducted using the five-point Likert scale. To analyze data, independent t-test, one-way ANOVA, Pearson correlation coefficients, and the Kruskal-Wallis test were employed.

RESULTS

The four dimensions in the Nonaka and Takeuchi model are based on optimal indicators (3.5), dimensions of combination, and externalization with an average of 3.3 were found in higher ranks and internalization and socialization had averages of 3.1 and 3. According to the findings of this study, the average knowledge management among faculty members of the Kerman University of Medical Sciences was estimated to be 3.1, with a bit difference compared to the average. According to the results of t-tests, there was no significant relationship between gender and various dimensions of knowledge management (p>0.05). The findings of Kruskal-Wallis showed that there is no significant relationship between variables of age, academic rank, and type of faculty with regard to dimensions of knowledge management (p>0.05). In addition, according to the results of Pearson tests, there is no significant relation between employment history and dimensions of knowledge management (p>0.05).

CONCLUSION

Considering the function and importance of knowledge management in education and research organizations including universities, it is recommended to pay comprehensive attention to establishment of knowledge management and knowledge sharing in universities and provide the required background to from research teams and communication networks inside and outside universities.

An extensible and successful method of identifying collaborators for National Library of Medicine informationist projects

QUESTION/PURPOSE

The New York University (NYU) Health Sciences Library used a new method to arrange in-depth discussions with basic science researchers. The objective was to identify collaborators for a new National Library of Medicine administrative supplement.

SETTING

The research took place at the NYU Health Sciences Library.

METHODS

Using the National Institutes of Health (NIH) RePORTER, forty-four researchers were identified and later contacted through individualized emails.

RESULTS

Nine researchers responded to the email followed by six in-person or phone discussions. At the conclusion of this process, two researchers submitted applications for supplemental funding, and both of these applications were successful.

CONCLUSIONS

This method confirmed these users could benefit from the skills and knowledge of health sciences librarians, but they are largely unaware of this.

Auditing Knowledge toward Leveraging Organizational IQ in Healthcare Organizations

Objectives

In this study, a knowledge audit was conducted based on organizational intelligence quotient (OIQ) principles of Iran's Ministry of Health and Medical Education (MOHME) to determine levers that can enhance OIQ in healthcare.

Methods

The mixed method study was conducted within the MOHME. The study population consisted of 15 senior managers and policymakers. A tool based on literature review and panel expert opinions was developed to perform a knowledge audit.

Results

The significant results of this auditing revealed the following: lack of defined standard processes for organizing knowledge management (KM), lack of a knowledge map, absence of a trustee to implement KM, absence of specialists to produce a knowledge map, individuals' unwillingness to share knowledge, implicitness of knowledge format, occasional nature of knowledge documentation for repeated use, lack of a mechanism to determine repetitive tasks, lack of a reward system for the formation of communities, groups and networks, non-updatedness of the available knowledge, and absence of commercial knowledge.

Conclusions

The analysis of the audit findings revealed that three levers for enhancing OIQ, including structure and process, organizational culture, and information technology must be created or modified.

Nurse managers' work life quality and their participation in knowledge management: a correlational study

Background:

The association between quality of work life and participation in knowledge management is unknown.

Objectives:

This study aimed to discover the association between quality of work life of nurse managers and their participation in implementing knowledge management.

Materials and Methods:

This was a correlational study. All nurse managers (71 people) from 11 hospitals affiliated with the Social Security Organization in Tehran, Iran, were included. They were asked to rate their participation in knowledge management and their quality of work life. Data was gathered by a researcher-made questionnaire (May-June 2012). The questionnaire was validated by content and construct validity approaches. Cronbach’s alpha was used to evaluate reliability. Finally, 50 questionnaires were analyzed. The answers were scored and analyzed using mean of scores, T-test, ANOVA (or nonparametric test, if appropriate), Pearson’s correlation coefficient and linear regression.

Results:

Nurse managers’ performance to implement knowledge management strategies was moderate. A significant correlation was found between quality of work life of nurse managers and their participation in implementing knowledge management strategies (r = 0.82; P < 0.001). The strongest correlations were found between implementation of knowledge management and participation of nurse managers in decision making (r = 0.82; P < 0.001).

Conclusions:

Improvement of nurse managers’ work life quality, especially in decision-making, may increase their participation in implementing knowledge management.

A qualitative content analysis of knowledge storage in nursing education system

Background:

The need for effective management of intellectual and academic assets is constantly growing. The nursing educational system should be considered as a storage of knowledge since it is deposited in the nursing educational system in the form of intellectual investment.

Objectives:

The purpose of the present study was to explore nursing knowledge storage in the nursing educational system.

Materials and Methods:

The participants of this study consisted of eight nursing educators and five students. The inductive content analysis method was used in this research. Participants were interviewed through the semi-structured method. Data analysis was done by five stage framework approaches. The trustworthiness of the study was ensured through validity and acceptability criteria.

Results:

Data analysis showed that nursing educators and students were involve in teaching and learning activities by storing knowledge in subjective and objective forms. Knowledge was gained through the different educational activities of the nursing educators and through contact with their peers. Moreover, the nursing students gained knowledge for better learning and a more knowledgeable and advanced performance with the help of the educators.

Conclusions:

This study revealed the main components of knowledge storage. An enhanced preservation of explicit knowledge is recommended in the nursing educational system so that in the future, students and educators can easily access the same knowledge from storage sources and not from individuals who might be carrying only a single experience of the subject.

Trend and Network Analysis of Common Eligibility Features for Cancer Trials in ClinicalTrials.gov

ClinicalTrials.gov has been archiving clinical trials since 1999, with > 165,000 trials at present. It is a valuable but relatively untapped resource for understanding trial design patterns and acquiring reusable trial design knowledge. We extracted common eligibility features using an unsupervised tag-mining method and mined their temporal usage patterns in clinical trials on various cancers. We then employed trend and network analysis to investigate two questions: (1) what eligibility features are frequently used to select patients for clinical trials within one cancer or across multiple cancers; and (2) what are the trends in eligibility feature adoption or discontinuation across cancer research domains? Our results showed that each cancer domain reuses a small set of eligibility features frequently for selecting cancer trial patients and some features are shared across different cancers, with value range adjustments for numerical measures. We discuss the implications for facilitating community-based clinical research knowledge sharing and reuse.

Synergistic relationships between Analytical Chemistry and written standards

This paper describes the mutual impact of Analytical Chemistry and several international written standards (norms and guides) related to knowledge management (CEN-CWA 14924:2004), social responsibility (ISO 26000:2010), management of occupational health and safety (OHSAS 18001/2), environmental management (ISO 14001:2004), quality management systems (ISO 9001:2008) and requirements of the competence of testing and calibration laboratories (ISO 17025:2004). The intensity of this impact, based on a two-way influence, is quite different depending on the standard considered. In any case, a new and fruitful approach to Analytical Chemistry based on these relationships can be derived.

Improving HIV/AIDS Knowledge Management Using EHRs

Background

A primary goal for the development of EHRs and EHR-related technologies should be to facilitate greater knowledge management for improving individual and community health outcomes associated with HIV / AIDS. Most of the current developments of EHR have focused on providing data for research, patient care and prioritization of healthcare provider resources in other areas. More attention should be paid to using information from EHRs to assist local, state, national, and international entities engaged in HIV / AIDS care, research and prevention strategies. Unfortunately the technology and standards for HIV-specific reporting modules are still being developed.

Methods:

A literature search and review supplemented by the author’s own experiences with electronic health records and HIV / AIDS prevention strategies will be used. This data was used to identify both opportunities and challenges for improving public health informatics primarily through the use of latest innovations in EHRs. Qualitative analysis and suggestions are offered for how EHRs can support knowledge management and prevention strategies associated with HIV infection.

Results:

EHR information, including demographics, medical history, medication and allergies, immunization status, and other vital statistics can help public health practitioners to more quickly identify at-risk populations or environments; allocate scarce resources in the most efficient way; share information about successful, evidenced-based prevention strategies; and increase longevity and quality of life.

Conclusion:

Local, state, and federal entities need to work more collaboratively with NGOs, community-based organizations, and the private sector to eliminate barriers to implementation including cost, interoperability, accessibility, and information security.

Inroads to predict in vivo toxicology-an introduction to the eTOX Project

There is a widespread awareness that the wealth of preclinical toxicity data that the pharmaceutical industry has generated in recent decades is not exploited as efficiently as it could be. Enhanced data availability for compound comparison (“read-across”), or for data mining to build predictive tools, should lead to a more efficient drug development process and contribute to the reduction of animal use (3Rs principle). In order to achieve these goals, a consortium approach, grouping numbers of relevant partners, is required. The eTOX (“electronic toxicity”) consortium represents such a project and is a public-private partnership within the framework of the European Innovative Medicines Initiative (IMI). The project aims at the development of in silico prediction systems for organ and in vivo toxicity. The backbone of the project will be a database consisting of preclinical toxicity data for drug compounds or candidates extracted from previously unpublished, legacy reports from thirteen European and European operation-based pharmaceutical companies. The database will be enhanced by incorporation of publically available, high quality toxicology data. Seven academic institutes and five small-to-medium size enterprises (SMEs) contribute with their expertise in data gathering, database curation, data mining, chemoinformatics and predictive systems development. The outcome of the project will be a predictive system contributing to early potential hazard identification and risk assessment during the drug development process. The concept and strategy of the eTOX project is described here, together with current achievements and future deliverables.

The adoption of electronic medical records and decision support systems in Korea

Objectives

To examine the current status of hospital information systems (HIS), analyze the effects of Electronic Medical Records (EMR) and Clinical Decision Support Systems (CDSS) have upon hospital performance, and examine how management issues change over time according to various growth stages.

Methods

Data taken from the 2010 survey on the HIS status and management issues for 44 tertiary hospitals and 2009 survey on hospital performance appraisal were used. A chi-square test was used to analyze the association between the EMR and CDSS characteristics. A t-test was used to analyze the effects of EMR and CDSS on hospital performance.

Results

Hospital size and top management support were significantly associated with the adoption of EMR. Unlike the EMR results, however, only the standardization characteristic was significantly associated with CDSS adoption. Both EMR and CDSS were associated with the improvement of hospital performance. The EMR adoption rates and outsourcing consistently increased as the growth stage increased. The CDSS, Knowledge Management System, standardization, and user training adoption rates for Stage 3 hospitals were higher than those found for Stage 2 hospitals.

Conclusions

Both EMR and CDSS influenced the improvement of hospital performance. As hospitals advanced to Stage 3, i.e. have more experience with information systems, they adopted EMRs and realized the importance of each management issue.