-
[show abstract]
[hide abstract]
ABSTRACT: This study examined how variations in the source and type of patient health data affected health care providers' perceptions of the trustworthiness and usefulness of the data. Overall, respondents (n=107) reported moderate to high levels of trust and usefulness of health status data from all sources. Technology sources were rated as more trustworthy than traditional, non-technology sources (paired t=-2.84, p<0.006). However, there was no significant difference between technology sources and non-technology sources (paired t=-1.63, p<0.108) in perceived usefulness for clinical decision making.
Studies in health technology and informatics 01/2013; 183:189-94.
-
[show abstract]
[hide abstract]
ABSTRACT: This paper discusses the design and development of a multi-user health kiosk intended for independent use by underserved populations. The modular integration of physiological sensors and psycho-social assessments provides an extensible, customizable platform for research. We present the development of the kiosk's feature set and user interaction mechanisms through iterative user testing, in addition to some technical challenges and solutions resulting from our design choices.
Studies in health technology and informatics 01/2013; 183:79-83.
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to demonstrate the range of emotional expressions that can be displayed by nurse and family caregiver during a telehospice videophone consultation. We hypothesized that a nurse providing telehospice care via videophone would gain access to rich nonverbal emotional signals from the caregiver and communicate her own social presence to the caregiver, to potentially enhance the building of empathy between nurse and caregiver.
Videorecording of a case exemplar of videophone contact was obtained using the Beamer, a commercially available product that allows display of both caller and receiver on an available television through standard telephone lines. Nonverbal communication through facial expressions of emotion was quantified using detailed coding of facial movement and expression (facial action coding system).
In this study, we demonstrated the presence of visual nonverbal information in the form of facial expressions of emotion during a videophone interaction between nurse and family caregiver. Over the course of a typical after-hours telehospice call, a variety of facial expressions of emotion were displayed by both nurse and family caregiver. Expression of positive and negative emotions, as well as mixed emotions, was apparent. Through detailed analysis of this case of videophone interaction, we have demonstrated the potential value of videophone contact for providing access to visual nonverbal emotional communication.
Telemedicine and e-Health 06/2011; 17(5):399-401. · 1.42 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Community-based (multi-user) telehealth interventions may be beneficial for older adults, but there is little research regarding such interventions. As a first step in feasibility assessment, we used a qualitative descriptive approach to examine the acceptability and perceived value of community-based telehealth kiosks with regard to current health self-management practices of community-dwelling older adults. Participants included residents (n = 6) and community agency case managers (n = 3) of a U.S. Department of Housing and Urban Development-subsidized senior apartment building. Both positive impressions from and concerns of each group are presented. Findings helped guide plans for future telehealth kiosk implementation and training.
Research in Gerontological Nursing 10/2010; 3(4):235-9. · 0.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This paper explores the role of clinical decision support systems (CDSS) in facilitating communication between physicians, nurses, patients and family members. Thirty-three critical care unit nurses and physicians were interviewed regarding the APACHE III CDSS. This qualitative, descriptive study suggests that registered nurses and physicians are primarily motivated to use CDSS when this technology allows them to forecast the potential outcomes of decisions prior to actually making those decisions. These forecasts are used to advocate for care decisions with other disciplines, patients and their family members. Implications for professional practice and recommendations for future research are described.
Journal of Medical Systems 03/2009; 33(1):59-65. · 1.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This paper explores how the Novice-to-Expert Nursing Practice framework can illuminate the challenges of and opportunities in implementing information technology (IT), such as clinical decision support systems (CDSS), in nursing practice.
IT implementation in health care is increasing; however, substantial costs and risks remain associated with these projects.
The theoretical framework of Novice-to-Expert Nursing Practice was applied to current design and implementation literature for CDSS.
Organizational policies and CDSS design affect implementation and user adoption.
Nursing CDSS can improve the overall quality of care when designed for the appropriate end-user group and based on a knowledge base reflecting nursing expertise.
Nurse administrators can positively influence CDSS function and end-user acceptance by participating in and facilitating staff nurse involvement in IT design, planning and implementation. Specific steps for nurse administrators and managers are included in this paper.
Journal of Nursing Management 10/2008; 16(6):692-9. · 1.18 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain.
Journal of the American Medical Informatics Association 02/2008; 15(1):8-13. · 3.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Demographic factors have been shown to be moderate predictors of preterm birth in prior studies which used hospital databases and epidemiologic sample surveys. This retrospective study used de-identified 2003 North Carolina birth certificate data (n=73,040) and replicated the statistical and computational methods used in a prior study of an academic medical center's data warehouse. Receiver Operating Characteristics (ROC) curves were used to compare results across methods. Due to differences between the data collected for birth certificates and the original clinical database, five of the seven demographic variables in the clinical database model were available for model testing (maternal age, marital status, race/ethnicity, education and county). Even with a reduced model, multiple methods of statistical and computational modeling supported the earlier findings of demographic predictors for preterm birth. The reduced model AUC results were acceptable (logistic regression = 0.605, neural networks = 0.57, SVM = 0.57, Bayesian classifiers = 0.59, and CART = 0.56), but lower than in the prior study as might be expected for a reduced model. On a population level, these results support a prior demographic predictor preterm birth model generated from a clinical database and the use of computational methods for model formation. Additional testing for stronger predictor models within birth certificate data is suggested as birth certificate data is a parsimonious population dataset already routinely collected.
Studies in health technology and informatics 02/2008; 136:555-60.
-
[show abstract]
[hide abstract]
ABSTRACT: Interdisciplinary teamwork is essential in the delivery of hospice services. Hospice agencies in the USA are required by law to follow an interdisciplinary approach to patient care. The goal of this study is to assess the current level of technology use in hospice Interdisciplinary Team (IDT) meetings and identify the areas where technology can be utilised to address the challenges or barriers that IDT meetings face. We conducted a semistructured phone survey using purposive sampling based on US hospice utilisation rates. The representatives of 190 agencies participated. The findings indicate that technology is not widely used in team meetings. Less than half of the agencies report computer use during meetings. The respondents saw benefits in using technology to access patient records and medication lists and design the care plan. Technology can become a powerful tool if introduced to enhance the social and product function of a group process.
International Journal of Electronic Healthcare 02/2008; 4(3-4):244-56.
-
[show abstract]
[hide abstract]
ABSTRACT: Community-based, multi-user telehealth interventions may be especially relevant for older adults who have multiple chronic illnesses and live in congregate settings such as naturally occurring retirement communities (NORCs). This mixed methods study explored implementation of a communal telehealth application in an urban NORC. This poster presents the first impressions of residents and community case managers.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 02/2008;
-
[show abstract]
[hide abstract]
ABSTRACT: At present, the vast majority of older adults reside in the community. Though many older adults live in their own homes, increasing numbers are choosing continuing care retirement communities (CCRCs), which range from independent apartments to assisted living and skilled-nursing facilities. With predictions of a large increase in the segment of the population aged 65 and older, a subsequent increase in demand on CCRCs can be anticipated. With these expectations, researchers have begun exploring the use of smart home information-based technologies in these care facilities to enhance resident quality of life and safety, but little evaluation research exists on older adults' acceptance and use of these technologies.
This study investigated the factors that influence the willingness of older adults living in independent and assisted living CCRCs to adopt smart home technology.
Participants (n = 14) were recruited from community-dwelling older adults, aged 65 or older, living in one of two mid-western US CCRC facilities (independent living and assisted living type facilities).
This study used a qualitative, descriptive approach, guided by principles of grounded theory research. Data saturation (or when no new themes or issues emerged from group sessions) occurred after four focus groups (n = 11 unique respondents) and was confirmed through additional individual interviews (n = 3).
The findings from this study indicate that although privacy can be a barrier for older adults' adoption of smart home technology their own perception of their need for the technology can override their privacy concerns.
Factors influencing self-perception of need for smart home technology, including the influence of primary care providers, are presented. Further exploration of the factors influencing older adults' perceptions of smart home technology need and the development of appropriate interventions is necessary.
Informatics in primary care 02/2008; 16(3):195-201.
-
[show abstract]
[hide abstract]
ABSTRACT: With the anticipated growth in the older adult population in the next few years, information designers are examining new ways for assistive technologies to support independent living and quality of life for adults as they age. Central to the role of assistive technology to support and enhance quality of life is the development of non-obtrusive technologies. Despite the importance of non-obtrusiveness to the design of assistive technologies, there remains no standard definition of obtrusiveness or measurement instrument. A conceptual framework for obtrusiveness in home telehealth technologies has recently been proposed but has not yet been tested empirically. This project performed a secondary analysis of focus group and interview data to explore the presence of the dimensions of the obtrusiveness framework in older adults' responses to information-based assistive technologies in residential care facilities. We found the existing data contained examples of each dimension (physical, usability, privacy, function, human interaction, self-concept, routine, and sustainability) and 16 of the 22 subcategories proposed by the obtrusiveness framework. These results provide general support for the framework, although further prospective validation research is needed. Potential enhancements to the framework are proposed.
Medical Informatics and the Internet in Medicine 10/2007; 32(3):241-9. · 1.04 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The US Congress established the designation of Critical Access Hospitals in 1997, recognising rural hospitals as vital links to health for rural and underserved populations. The intent of the reimbursement system is to improve financial performance, thereby reducing hospital closures. Informatics applications are thought to be tools that can enable the sustainability of such facilities. The aim of this study is to identify the current use of information and communication technology in Critical Access Hospitals, and to assess their readiness and receptiveness for the use of new software and hardware applications and their perceived information technology (IT) needs. A survey was mailed to the administrators of all Critical Access Hospitals in one US state (Missouri) and a reminder was mailed a few weeks later. Twenty-seven out of 33 surveys were filled out and returned (response rate 82%). While most respondents (66.7%) stated that their employees have been somewhat comfortable in using new technology, almost 15% stated that their employees have been somewhat uncomfortable. Similarly, almost 12% of the respondents stated that they themselves felt somewhat uncomfortable introducing new technology. While all facilities have computers, only half of them have a specific IT plan. Findings indicate that Critical Access Hospitals are often struggling with lack of resources and specific applications that address their needs. However, it is widely recognised that IT plays an essential role in the sustainability of their organisations. The study demonstrates that IT applications have to be customised to address the needs and infrastructure of the rural settings in order to be accepted and properly utilised.
Informatics in primary care 02/2007; 15(1):45-51.
-
[show abstract]
[hide abstract]
ABSTRACT: Critical Access Hospitals (CAHs) were established as a category of limited service hospitals eligible for Medicare reimbursement based on a reasonable cost basis rather than a prospective payment system. This program aims,among other things, to enable rural facilities to address deferred capital improvements including information technology needs. The aim of this study is to identify the current use as well as readiness for the use of telehealthapplications in CAHs. A survey including 17 items was mailed to the administrators of all CAHs in one US state(Missouri). Twenty seven out of 33 surveys were returned. Information technology priorities included Electronic Medical Records (for 63% of respondents) and telehealth and bar code systems (for 23% of the respondents). Most respondents (66.7%) stated that their employees have been somewhat comfortable in using new technology. In a ChiSquare analysis CAH size (in number of employees) had no significant relationships (p<0.05) with the current telehealth resources in use, forecasted IT spending, or the perceived benefits of telehealth. Findings indicate that telehealth applications are currently underutilized in CAHs while it is recognized that telehealth can play an essential role in the sustainability of these organizations and quality improvement of their services.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2007;
-
[show abstract]
[hide abstract]
ABSTRACT: In response to federal law, which requires hospices to provide end-of-life care in an interdisciplinary team format, most hospices conduct team meetings to coordinate holistic plans of care for patients. The goal of this study was to uncover the structural characteristics of hospice interdisciplinary team meetings and learn more about common practices among hospice organizations. A total of 191 hospice agencies participated in a semi-structured phone survey regarding interdisciplinary team practices. The study found that not all hospices are fulfilling federally regulated requirements. Although the average hospice interdisciplinary team meeting is held once a week, lasts 1 to 2 hours, and consists of 10 to 20 people, this study reveals variation within the number and types of disciplines participating in interdisciplinary team meetings. Suggestions for future action are provided.
Journal of Hospice and Palliative Nursing 12/2006; 9(1):17-21. · 0.38 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This project reports on the experience of two hospice caregivers using videophone technology to enhance communication with their care providers. The data show the overall satisfaction and technical feasibility with videophone technology in home hospice. The case studies have great implication for future research because they reveal many unexpected issues relevant for future large-scale interventions.
Journal of Palliative Medicine 05/2006; 9(2):264-7. · 1.85 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: "Smart homes" are defined as residences equipped with sensors and other advanced technology applications that enhance residents' independence and can be used for aging in place. The objective of this study is to determine design specifications for smart residences as defined by professional groups involved both in care delivery to senior citizens and development of devices and technologies to support aging. We assessed the importance of specific devices and sensors and their advantages and disadvantages as perceived by the interdisciplinary expert team. This work lays the ground for the implementation of smart home residencies and confirms that only an interdisciplinary design approach can address all the technical, clinical and human factors related challenges associated with home-based technologies that support aging. Our findings indicate that the use of adaptive technology that can be installed in the home environment has the potential to not only support but also empower individual senior users.
Studies in health technology and informatics 02/2006; 124:45-50.
-
JAMIA. 01/2006; 13:428-431.
-
Behaviour & IT. 01/2006; 25:233-237.
-
Karen L Courtney
[show abstract]
[hide abstract]
ABSTRACT: Health services literature suggests that geographic information systems (GIS) are useful policy evaluation tools when policy success is dependent on location. Nursing workforce distribution is an inherently local issue and nursing shortages present serious concerns for local, state and national governments. In 1991, Missouri enacted a nurse recruitment and retention policy targeting underserved (HPSA-designated) counties. Following Institutional Review Board approval, policy effectiveness was explored using a combination of GIS data visualization, spatial and classic statistics. Results of both data visualization and statistical methods do not demonstrate an expected trend of decreasing group differences between HPSA and non-HPSA-designated counties over time. Only two of the five time periods studied had significant group differences. Between 1993 and 1995, the loss in nurse to population ratios in HPSA counties was significant (U=1020, p<0.001); however, between 1999 and 2001, the growth in nurse to population ratio changes in HPSA counties was significant (U=1032, p=0.001). The GIS data visualization and statistical techniques performed suggest that current policy definitions of underserved areas may not be effective in defining areas of nursing shortages and the existing policy implementation may not be achieving the stated goals.
International Journal of Medical Informatics 12/2005; 74(11-12):980-8. · 2.41 Impact Factor
