Health Informatics Journal

Published by SAGE Publications
Online ISSN: 1460-4582
Publications
Nesting in the EHR. EHR: Electronic Health-Care Record. 
Correctable oversights in the ISO EN 13606 Standard. 
Errors in the ISO EN 13606 Standard. 
Exmaple Software Or Device information. 
Article
The five parts of the ISO EN 13606 standard define a means by which health-care records can be exchanged between computer systems. Starting within the European standardisation process, it has now become internationally ratified in ISO. However, ISO standards do not require that a reference implementation be provided, and in order for ISO EN 13606 to deliver the expected benefits, it must be provided not as a document, but as an operational system that is not vendor specific. This article describes the evolution of an Extensible Markup Language (XML) Schema through three iterations, each of which emphasised one particular approach to delivering an executable equivalent to the printed standard. Developing these operational versions and incorporating feedback from users of these demonstrated where implementation compromises were needed and exposed defects in the standard. These are discussed herein. They may require a future technical revision to ISO EN 13606 to resolve the issues identified.
 
Article
The internet, though an invaluable and ubiquitous resource for health-related information, is perceived as being undermined by concerns about quality and reliability. Some recent developments, by permitting so-called user-generated content to be published on the internet, exacerbate these concerns. The impact of these developments, mostly characterized as Web 2.0, on the use of healthcare educational and information resources is explored in this article. There is a recognized need for an authoritative service that can address issues of quality. Intute: Health and Life Sciences is one such service, and its design in the context of meeting current Web 2.0 expectations and addressing concerns about quality is the focus of the article.
 
Article
The NHS and Social Care Model - a blueprint supporting organisations in improving services for people with long-term conditions (LTCs) - noted options to support people with LTCs might include technological tools supporting personalised care and choice and providing resources for patients to self-care and self-manage. Definitions concerning the integration of health information and support with Web 2.0 technology are primarily concerned with approaches from the healthcare perspective. There is a need to design a patient centred framework, encapsulating the use of Web 2.0 technology for people with LTCs who want to support, mitigate or improve quality of life. Existing theoretical frameworks offer a means of informing the design and measurement of this framework. This article describes how Web 2.0 technology could impact on the quality of life of individuals with LTCs and suggests a starting point for developing a theoretically informed patient centred framework.
 
Article
This prospective questionnaire study investigated access to the Internet and use of the Internet for health related information. Patients attending the senior author's ENT clinic (204 in 2000; 209 in 2006) were asked two questions: do you have access to the Internet? Have you used the Internet to find health related information? Access to the Internet rose from 43 per cent (88) in 2000 to 70 per cent (147) in 2006, a significant increase (p < 0.001). The Internet was used for health related information by only 32 patients (16%) in 2000 but by 114 (55%) in 2006, a dramatic and significant increase (p < 0.001). Clearly patients and their families are increasingly using the Internet to access and seek health information. Clinicians cannot overlook this aspect of health provision when seeking to facilitate the transmission of information to their patients.
 
Descriptive statistics and chi-square test of change in Internet usage of older adults between 2004 and 2010, with the variables: cognition, extraversion, openness, functional disability, household economy, age, sex and education. 
Logistic regression. 
Stepwise logistic regression, selecting only the older adults between 60-80 years of age. 
Article
The increased reliance on Internet use in social functions has presumably left out a part of the population: the oldest-older adults. These are people who have not kept themselves up to date with the technological developments for various reasons. There are, however, exceptions from whom we have something to learn. This study investigates the older people in Sweden who started to use the Internet over a period of 6 years. Cognition, extraversion, openness, functional disability, household economy, sex, age and education were investigated in relation to starting to use the Internet. A chi-square test, Spearman correlation and a logistic regression analysis were conducted. It was found that higher cognition, being male and being between the ages of 60 and 80 years were determining factors in starting to use the Internet for the Swedish older adult. Our results indicate that the oldest-older adults are slow to adapt to using the Internet and more attention should be paid on how to support this group.
 
Article
Unlabelled: Prior to the 2012 London Olympic and Paralympic Games, new statistical methods had to be developed for the enhanced syndromic surveillance during the Games. Different methods were developed depending on whether or not historical data were available. Practical solutions were needed to cope with the required daily reporting and data quality issues. During the Games, nearly 4800 signals were tested on average each day, generating statistical alarms that were assessed to provide information on areas of potential public health concern and reassurance that no major adverse incident had occurred. Graphical abstract: spjhi;21/2/159/FIG41460458213517577 F1 fig4-1460458213517577.
 
Demographics and dimensions of health information literacy 
Motivation factors and dimensions of health information literacy 
Article
This article examines the health information literacy of elderly Finns. The results are based on a survey conducted in January 2011. The questionnaire was distributed to 1000 persons that were randomly drawn from the Finnish Population Register. The respondents were aged 65-79 years (mean age 70 years) and lived in the Turku region in Finland. A total of 281 questionnaires (28%) were returned. χ(2) analyses were used to find possible relationships between demographic factors, as well as interest, seeking activity, current self-rated health and different dimensions of health information literacy, including needs, seeking and use of health-related information. Significant relationships were found between education level, interest in health information, seeking activity, self-rated current health and dimensions of health information literacy. Some categories of elderly people are more vulnerable regarding obtaining and use of health information: those with lower levels of education, those with poor health, and those who are not interested in and active at seeking information. For people who are found in any of these categories, it is important that available health-related information is understandable and can be accessed without too much effort-something that information providers should take into account.
 
Percentage of regular internet users (access at least once per week) across all age groups.  
Demographics of patients who participated across all age groups 
Percentage of patients that access their emails at least once per week for weekly internet users only (n=86) and the total sample (n=112).  
Percentage of patients that are confident at reading SMS text messages for those that own a mobile phone only (n=104) and the total sample (n=112).  
Article
Short message service (SMS) and email reminders have the potential to improve adherence to appointments and medication taking. Within the UK, information and communication technology (ICT) is widely used with a very high proportion of people having access to the internet and mobile phones. Little is known about ICT use by older adults and those with chronic illness. A feasibility survey was carried out with 112 rheumatology patients in Hertfordshire, UK to determine their current use of the internet, email and SMS and their willingness to receive electronic reminders in the future. A high proportion of patients up to age 65 are successfully using ICT despite older age or functional disability caused by rheumatic disease. Forty-four percent would be willing to receive an electronic appointment reminder and 25% a medication reminder. The results suggest that reminders would be welcomed by some patients and extensive patient training would not be needed before implementation.
 
Backward logistic regression with Internet use as a dependent variable and six independent variables: gender, education, living with someone or alone, normal cognitive functioning, household economy, age and living urban or rural. 
Backward logistic regression: urban Internet usage as dependent variable and gender, education, living with someone/alone, normal cognitive functioning, household economy and age as independent variables. 
Backward logistic regression: rural Internet usage as dependent variable and gender, education, living with someone or alone, normal cognitive functioning, household economy and age as independent variables. 
Article
Older adults living in rural and urban areas have shown to distinguish themselves in technology adoption; a clearer profile of their Internet use is important in order to provide better technological and health-care solutions. Older adults' Internet use was investigated across large to midsize cities and rural Sweden. The sample consisted of 7181 older adults ranging from 59 to 100 years old. Internet use was investigated with age, education, gender, household economy, cognition, living alone/or with someone and rural/urban living. Logistic regression was used. Those living in rural areas used the Internet less than their urban counterparts. Being younger and higher educated influenced Internet use; for older urban adults, these factors as well as living with someone and having good cognitive functioning were influential. Solutions are needed to avoid the exclusion of some older adults by a society that is today being shaped by the Internet.
 
Article
Robust data measurement systems assess health care performance and monitor population-level treatment trends. A key challenge in the assessment of substance abuse treatment is the development of systems to accurately monitor service delivery indicators. Wait time to treatment, as defined by the days between first request for service and first treatment, is an important measure of organizational process and delivery of care. The Network for the Improvement of Addiction Treatment emphasizes wait time as a primary outcome in their study of 201 addiction treatment agencies in the USA. This article describes the changes made in five state data systems to monitor wait times and outlines lessons learned that could be applied to other health data tracking systems.
 
Article
This article presents the usability and acceptability of a website that provides older people with tailored advice to help motivate them to undertake physical activities that prevent falls. Views on the website from interviews with 16 older people and 26 sheltered housing wardens were analysed thematically. The website was well received with only one usability difficulty with the action plan calendar. The older people selected balance training activities out of interest or enjoyment, and appeared to carefully add them into their current routine. The wardens were motivated to promote the website to their residents, particularly those who owned a computer, had balance problems, or were physically active. However, the participants noted that currently a minority of older people use the Internet. Also, some older people underestimated how much activity was enough to improve balance, and others perceived themselves as too old for the activities.
 
The original version of the Technology Acceptance Model. Figure taken by Holden & Karsh 3 . 
The revised Technology Acceptance Model. Figure taken by Holden & Karsh 3 . 
Article
The response of health professionals to the use of health information technology (HIT) is an important research topic that can partly explain the success or failure of any HIT application. The present study applied a modified version of the revised technology acceptance model (TAM) to assess the relevant beliefs and acceptance of HIT systems in a sample of health professionals (n = 133). Structured anonymous questionnaires were used and a cross-sectional design was employed. The main outcome measure was the intention to use HIT systems. ANOVA was employed to examine differences in TAM-related variables between nurses and medical doctors, and no significant differences were found. Multiple linear regression analysis was used to assess the predictors of HIT usage intentions. The findings showed that perceived ease of use, but not usefulness, relevance and subjective norms directly predicted HIT usage intentions. The present findings suggest that a modification of the original TAM approach is needed to better understand health professionals' support and endorsement of HIT. Perceived ease of use, relevance of HIT to the medical and nursing professions, as well as social influences, should be tapped by information campaigns aiming to enhance support for HIT in healthcare settings.
 
Article
As modern healthcare shifts towards a patient-centric model, there is an increasing emphasis on teamwork. Legacy healthcare information systems are ill equipped to meet new requirements arising from this change. Many projects have been undertaken to address various aspects of the challenge of supporting patient-centric work. In the UK, development and adoption of a unified electronic patient record (EPR) that serves practitioners across the country is a high priority. This article considers what additional support healthcare teams will require beyond the cross-discipline unified EPR. A system that considers practitioners as part of a patient's care team and which tracks teams and professional roles is proposed and evaluated as a means to provide each practitioner with a view of the EPR appropriate to his/her professional role and to provide improved support for collaboration among team members.
 
Article
This project investigates public attitudes towards sharing confidential personal health information held in electronic health records (EHRs). The project uses computer assisted telephone interviewing (CATI) to conduct a quantitative national survey of the attitudes of New Zealanders towards access to their personal health information using vignettes. Respondents are presented with vignettes which describe ways in which their health information might be used, and asked about their attitude to and consent for each type of access. The project outcome will be a specification of requirements for an e-consent model meeting the needs of most New Zealanders, thus enabling the potential benefits of electronically sharing confidential health information from EHRs. This article presents preliminary results from the first 1828 respondents. Respondents were most willing to share their information for the purpose of providing care. However, removing their name and address greatly increased the acceptability of sharing information for other purposes.
 
Schematic presentation of the data base management (DBM) process and the data fl ow for extraction, cleansing and enrichment of data from a semi-structured EMR Journal III® (Profdoc®). The picture shows both how various functions such as validation tests, reports etc. could be run directly from the SQL database, and the tools used such as MS Access and SAS statistical packages. The fi gure also shows how direct queries and reports for medical review are made while accessing the data via the ODBC layer (Open Data Base Connectivity, a standard database access method developed by the SQL Access Group in 1992)
Type of antihypertensive drugs used by year. Data from EMRs in an outpatient general practice clinic (776 patients with diabetes mellitus) for the period 2001–2005. The graph shows the percentage of patients with at least one antihypertensive drug of the various types during the 5 year study period. Patients with several prescriptions of the same drug class during a specifi c year were only counted once. Patients with more than one recording per year were averaged to give population average per year. Number of patients by year: 2000, 492; 2001, 520; 2002, 543; 2003, 590; 2004, 621  
Article
The use of clinical data from electronic medical records (EMRs) for clinical research and for evaluation of quality of care requires an extraction process. Many efforts have failed because the extracted data seemed to be unstructured, incomplete and ridden by errors. We have developed and tested a concept of extracting semi-structured EMRs (Journal III, Profdoc) data from 776 diabetes patients in a general practice clinic over a 5 year period. We used standard database management techniques commonly applied in clinical research in the pharmaceutical industry to clean up the data and make the data available for statistical analysis. The key problem was difficulties locating the data, as no standard way to enter the data in the EMR system was reinforced. Furthermore, no built-in edit checks to facilitate data entry were available. Laboratory, drug information and diagnostic data could be used directly while other data such as vital signs required much work to locate and become useful.
 
Article
The Internet is an oft-cited learning resource, useful to consumers who seek to educate themselves on specific technical issues or knowledge-intensive topics. Availability of public-access Internet portals and decreasing costs of personal computers have created a consensus that unequal access to information, or a "Digital Divide", presents a like problem specific to information for uninsured or under-insured healthcare consumers. Access to information, however, is now an essential part of consumer-centric healthcare management. To date little research has been done to differentiate levels of health information access on the Web by different subgroups, linking online socioeconomic characteristics and health seeking behaviors. This analysis of a landmark Pew Foundation survey seeks to differentiate and delineate information access, or lack of desired access, across targeted, "digitally underserved" subgroups.
 
Location of hospitals with emergency departments 
Article
In the current political climate of evidence-based research, GIS has emerged as a powerful research tool as it allows spatial and social health inequality to be explored efficiently. This article explores the impact health reforms had on geographical accessibility to hospital emergency department (ED) services in New Zealand from 1991 to 2001. Travel time was calculated using least-cost path analysis, which identified the shortest travel time from each census enumeration district through a road network to the nearest ED. This research found that the population further than 60 minutes from an ED has increased with some areas being affected more than others. Some of this increase is attributed to increases in population rather than the closing of hospitals. The findings will be discussed within the context of the health policy reform era and changes to health service provision.
 
Article
Two widely discussed and debated aspects of health law literature are 'informed' consent to medical treatment and the right of access to personal health information. Both are tied to the larger subject of patients' rights, including the right to privacy. This article looks at the issue of informed consent internationally, and goes further to explain some of the inequalities across the world with respect to informed consent and patients' rights legislation via an analysis of the take-up of key legislative attributes in patient consent. Specifically, the effect that national culture, as defined by the GLOBE variables, has on the rate and pattern of adoption of these consent elements is analysed using binary logistic regression to provide evidence of the existence or otherwise of a cultural predicate of the legislative approach. The article concludes by outlining the challenges presented by these differences.
 
Article
Computer illiteracy is diminishing as a new generation of retirees become the younger old and display more up-to-date knowledge and skills. However, there are questions about whether this group will be able to continue to update their skills as they get older, and whether it is appropriate to develop technology solutions specifically for this age group or to concentrate on accessible designs for the whole population. We propose that older people may be empowered through involvement in the design and provision of accessible information and technology solutions and through training opportunities in information seeking skills. Access, involvement and training need to be provided in everyday locations, and training needs to be closely related to people's physical, cognitive and information needs and those of the particular communities where they live. These issues are explored using evidence from a number of research projects conducted by the authors.
 
Article
This article reports redesign strategies identified to create a Web-based user-interface for the Self-management TO Prevent (STOP) Stroke Tool. Members of a Stroke Quality Improvement Network (N = 12) viewed a visualization video of a proposed prototype and provided feedback on implementation barriers/facilitators. Stroke-care providers (N = 10) tested the Web-based prototype in think-aloud sessions of simulated clinic visits. Participants' dialogues were coded into themes. Access to comprehensive information and the automated features/systematized processes were the primary accessibility and usability facilitator themes. The need for training, time to complete the tool, and computer-centric care were identified as possible usability barriers. Patient accountability, reminders for best practice, goal-focused care, and communication/counseling themes indicate that the STOP Stroke Tool supports the paradigm of patient-centered care. The STOP Stroke Tool was found to prompt clinicians on secondary stroke-prevention clinical-practice guidelines, facilitate comprehensive documentation of evidence-based care, and support clinicians in providing patient-centered care through the shared decision-making process that occurred while using the action-planning/goal-setting feature of the tool.
 
Article
This article presents a study to evaluate the accuracy of drug interaction (DI) alerts triggered by two electronic medical record (EMR) systems in primary healthcare. A scenario-based software architecture analysis methodology (SAAM) was used with drug-drug interaction (DDI) pairs in hypothetical patient scenarios. A literature search identified common drugs used in the management of conditions in the elderly population. Three reference programs determined the level of severity of drug interactions, and a common severity rating scale was adapted. The EMR systems showed a limited potential to identify 'severe' clinically significant DDIs and considerable probability for triggering spurious alerts. This may explain the overriding of DI alerts and the interruption of the workflow of users of EMR systems. Reasons for EMR system deficiency included unavailable updates or programming, database functioning discrepancies, and controversies in the clinical evidence.
 
Article
Accurate and timely clinical data are required for clinical and organisational purposes and is especially important for patient management, audit of surgical performance and the electronic health record. The recent introduction of computerised theatre management systems has enabled real-time (point-of-care) operative procedure coding by clinical staff. However the accuracy of these data is unknown. The aim of this Scottish study was to compare the accuracy of theatre nurses' real-time coding on the local theatre management system with the central Scottish Morbidity Record (SMR01). Paired procedural codes were recorded, qualitatively graded for precision and compared (n = 1038). In this study, real-time, point-of-care coding by theatre nurses resulted in significant coding errors compared with the central SMR01 database. Improved collaboration between full-time coders and clinical staff using computerised decision support systems is suggested.
 
The SUP solution 25  
Design challenges and principles (inspired by Hanseth and Lyytinen 9 )
Analysis of SUP project based on design principles
Article
Achieving integrated healthcare information systems has become a common goal for many countries in their pursuit of obtaining coordinated and comprehensive healthcare services. This article focuses on how a small local project termed 'Standardized pull of patient data' expanded and is now used on a large scale providing a majority of hospitals, general practitioners and citizens across Denmark with the possibility of accessing healthcare data from different electronic patient record systems and other systems. I build on design theory for information infrastructures, as presented by Hanseth and Lyytinen, to examine the design principles that facilitated this smallscale project to expand and become widespread. As a result of my findings, I outline three lessons learned that emphasize: (i) principles of flexibility, (ii) expansion from the installed base through modular strategies and (iii) identification of key healthcare actors to provide them with immediate benefits.
 
Article
This article describes a study of a major change management project involving the establishment of a shared services organization to align the information services functions for two district health boards in New Zealand. The research uncovered a capability crisis that many people experienced when they realized the magnitude of the task they were involved in. Not everyone experienced the crisis and it seems that learning, especially in a complex healthcare environment, plays an important role in reducing the negative impact of change.
 
Care worker experience of PDA usage (%, 2008).
Article
The diffusion and adoption of information technology innovations (e.g. mobile information technology) in healthcare organizations involves a dynamic process of change with multiple stakeholders with competing interests, varying commitments, and conflicting values. Nevertheless, the extant literature on mobile information technology diffusion and adoption has predominantly focused on organizations and individuals as the unit of analysis, with little emphasis on the environment in which healthcare organizations are embedded. We propose the social worlds approach as a promising theoretical lens for dealing with this limitation together with reports from a case study of a mobile information technology innovation in elderly home care in Denmark including both the sociopolitical and organizational levels in the analysis. Using the notions of social worlds, trajectories, and boundary objects enables us to show how mobile information technology innovation in Danish home care can facilitate negotiation and collaboration across different social worlds in one setting while becoming a source of tension and conflicts in others. The trajectory of mobile information technology adoption was shaped by influential stakeholders in the Danish home care sector. Boundary objects across multiple social worlds legitimized the adoption, but the use arrangement afforded by the new technology interfered with important aspects of home care practices, creating resistance among the healthcare personnel.
 
Order of the implementation of the seven projects of Project Fusion  
• 25 project team • One person rebuilt all the computers • 11 people on helpdesk handled user support
Article
Shared services organizations are ascribed with adding value to business in several ways but especially by sharing resources and leading to economies of scale. However, these gains are not automatic and in some instances, particularly healthcare, they are difficult to achieve. This article describes a project to develop a shared services information technology infrastructure across two district health boards in New Zealand. The study reveals valuable insight into the crisis issues that accompany change management and identifies emergent themes that can be used to reduce negative impact.
 
Article
Communication with patients is vital in their management, and the NHS plan to copy clinic letters to patients was published in 2004. This study aims to determine whether patients are satisfied with their current communication or prefer alternative modes, overall and between different specialty clinics. A questionnaire was given to outpatients attending clinics in November to December 2006. A total of 483 patients returned the questionnaire, giving a 95 per cent response rate. Overall, 85 per cent of patients were satisfied with the current method of communication, and a significant number did want a copy of GP letters. Trend analysis suggests that, as the number of clinic visits increased, requests for copies of letters decreased (p = 0.02). Paediatric and psychiatric patients were more likely to want letters than medical and surgical patients (p = 0.003). Thus communication needs may differ between departments. Opt-in letter copy systems seem preferable.
 
Article
This paper describes the experiences of the Eastern Head Injury Study in creating a strategic regional head injury service framework using a collaborative action research methodology. The types of data, information and knowledge required to develop and support such a framework for both development and successful implementation are identified. This includes the identification of existing knowledge/information systems, the variability and gaps in these, and how the systems fit together, using a number of evidence-gathering and knowledge-sharing methods. The discussion debates the value of the action research approach and what principles are necessary in developing and maintaining knowledge networks. The project demonstrates that an understanding of the social learning cycle can help in understanding how the pieces fit together, and how the information systems need to be in place to provide the information (or data or knowledge) in the appropriate format to make the learning possible.
 
Article
Electronic patient record (EPR) systems have a huge impact on nursing documentation. Although the largest group of end-users of EPRs, nurses have had minimal input in their design. This study aimed to review current research on how nurses experience using the EPR for documentation. A literature search was conducted in Medline and Cinahl of original, peer-reviewed articles from 2000 to 2009, focusing on nurses in acute/ inpatient ward settings. After critical assessment, two quantitative and three qualitative articles were included in the study. Results showed that nurses experience widespread dissatisfaction with systems. Current systems are not designed to meet the needs of clinical practice as they are not user-friendly, resulting in a potentially negative impact on individualized care and patient safety. There is an urgent need for nurses to be directly involved in software design to ensure that the essence and complexity of nursing is not lost in the system.
 
ViEWS. 21 
Article
Vital sign documentation is crucial to detecting patient deterioration. Little is known about the documentation of vital signs in electronic health records. This study aimed to examine documentation of vital signs in electronic health records. We examined the vital signs documented in the electronic health records of patients who had suffered an in-hospital cardiac arrest and on whom cardiopulmonary resuscitation was attempted between 2007 and 2011 (n = 228), in a 372-bed district general hospital. We assessed the completeness of vital sign data compared to VitalPAC™ Early Warning Score and the location of vital signs within the electronic health records. There was a noticeable lack of completeness of vital signs. Vital signs were fragmented through various sections of the electronic health records. The study identified serious shortfalls in the representation of vital signs in the electronic health records, with consequential threats to patient safety.
 
Article
Interventions aiming to help ethnically diverse emerging adults engage in healthy eating have had limited success. The aim of this study was to assess the feasibility of and adherence to an intervention capitalizing on mobile technology to improve healthy eating. Participants created an online photo food journal and received motivational text messages three times a day. Satisfaction with the intervention was assessed, as were control variables including depression and body dissatisfaction. In addition, weight and height were measured. Levels of adherence to the photo food journal were high with approximately two photos posted a day at baseline. However, adherence rates decreased over the course of the study. Body dissatisfaction positively predicted adherence, while body mass index negatively predicted study satisfaction. Mobile technology provides innovative avenues for healthy eating interventions. Such interventions appear acceptable and feasible for a short period; however, more work is required to evaluate their viability regarding long-term engagement. © The Author(s) 2015.
 
Article
The validity of administrative data may be vulnerable to how well physicians document medical charts. The objective of this study is to determine the relationship between chart documentation quality and the validity of administrative data. The charts for patients who underwent carotid endarterectomy were re-abstracted and rated for the quality of documentation. Poorly and well-documented charts were compared by patient, physician, and hospital variables, as well as on agreement between the administrative and re-abstracted data. Of the 2061 charts reviewed, 42.6 per cent were rated well documented. The proportion of charts well documented varied from 14.6 to 87.5 per cent across 17 hospitals, but did not vary significantly by patient characteristics. The kappa statistic was generally higher for well-documented charts than for poorly documented charts, but varied across comorbidities. In conclusion, poorly documented hospital charts tend to be translated into invalid administrative data, which reduces the communication of clinical information among healthcare providers.
 
Article
Many medical organizations have implemented electronic health record (EHR) and health information exchange (HIE) networks to improve medical decision-making. This study evaluated the contribution of EHR and HIE networks to physicians by investigating whether health information technology can lead to more efficient admission decisions by reducing redundant admissions in the stressful environment of emergency. Log-files were retrieved from an integrative and interoperable EHR that serves seven main Israeli hospitals. The analysis was restricted to a group of patients seen in the emergency departments who were administered a Creatinine test. The assessment of the contribution of EHR to admission decisions used various statistical analyses and track log-file analysis. We showed that using the EHR contributes to more efficient admission decisions and reduces the number of avoidable admissions. In particular, there was a reduction in readmissions when patient history was viewed. Using EHR can help respond to the international problem of avoidable hospital readmissions.
 
Screenshot of inpatient dashboard, where columns indicate net patient flow (horizontal axis is 4-hourly time blocks across the day; values above the line are net patient admissions, values below are net patient discharges). 
Interview participants. 
Screenshot of Predicted 10 day outlook, where the bottom line indicates net patient flow. 
Article
Emergency department overcrowding is an increasing issue impacting patients, staff and quality of care, resulting in poor patient and system outcomes. In order to facilitate better management of emergency department resources, a patient admission predictive tool was developed and implemented. Evaluation of the tool's accuracy and efficacy was complemented with a qualitative component that explicated the experiences of users and its impact upon their management strategies, and is the focus of this article. Semi-structured interviews were conducted with 15 pertinent users, including bed managers, after-hours managers, specialty department heads, nurse unit managers and hospital executives. Analysis realised dynamics of accuracy, facilitating communication and enabling group decision-making. Users generally welcomed the enhanced potential to predict and plan following the incorporation of the patient admission predictive tool into their daily and weekly decision-making processes. They offered astute feedback with regard to their responses when faced with issues of capacity and communication. Participants reported an growing confidence in making informed decisions in a cultural context that is continually moving from reactive to proactive. This information will inform further patient admission predictive tool development specifically and implementation processes generally. © The Author(s) 2015.
 
Model calibration performance.  
Model Discriminative Performance.
Article
To develop an automated risk prediction model to identify elderly patients at high risk of emergency admission to medical wards within 28 days following an index hospital visit. A retrospective data analysis of 41 hospitals and 48 specialist outpatient clinics in Hong Kong. The study subjects were elderly patients aged 65 years or above, who had index hospital visit(s) in the year of 2005, which included hospitalizations at medical wards and attendances at the accident and emergency departments or specialist outpatient clinics for medical conditions. Multiple logistic regression was used to estimate the risk of emergency medical admission in 28 days after an index hospital visit. Model validation was performed against the complete cohort in 2006. Over a million of episodes were included in the derivation cohort. A total of 14 predictor variables included patient socio-demographics, service utilization in the previous year, presence and number of chronic diseases and type of index episode. The model has a good discriminative ability with the area under receiver-operating characteristic curve at 0.819 and 0.824 for the derivation and validation cohorts, respectively. The model has a sensitivity of 70.3 per cent, specificity of 78.4 per cent, positive predictive value of 21.7 per cent and negative predictive value of 96.9 per cent. This simple, accurate and objective risk prediction model has been computerized into an automated screening tool to recruit high-risk elderly patients discharged from all public hospitals in Hong Kong into the Community Health Call Centre service with an aim to prevent avoidable hospitalizations.
 
Logistic regression: Predictive associations of Emergency Department (ED) admits to Intensive Care Units (ICUs) on hospital mortality 
Age of race and percent mortality 
Descriptive statistics race to mortality based on International Classification of Diseases (ICD)- 9CMcategory.Hispanics had the highest percentage of uninsured and mortality rate per category. Two additional categories included Asians and others. Both Asians and others had no statistical significant findings based on race owing to the limited sample size 
Article
When collecting data from a single electronic medical record (EMR), few studies of Intensive Care Unit (ICU) patients admitted directly from an Emergency Department (ED) focus on observational methodologies examining occupancy of both the ICU and the ED, and population characteristics. This quantitative study design and analysis, with a sample size of 1433 cases using regression techniques, suggested odds of mortality were more likely with a higher ICU occupancy/census and if uninsured. There was no statistical difference based on ED occupancy/census at time of decision to admit to an ICU and no difference whether admitted on a weekend or weekday. Inpatient ICU occupancy is one of the variables that impacts waiting time and overcrowding in the ED, and, in this study, inpatient occupancy in the ICUs impacted patient outcomes. As all healthcare providers make up the interprofessional team and work within complex systems, ease of retrieval of EMR data can hasten decision support to improve quality outcomes.
 
Article
This study uses hospital administrative data to ascertain the differences in the patient characteristics, process and outcomes of care between the Emergency Department (ED) triage categories of patients admitted from an ED presentation into a large metropolitan teaching hospital with a Stroke Care Unit. Bayesian Networks (BNs) derived from the administrative data were used to provide the descriptive models. Nearly half the patients in each stroke subtype were triaged as 'Urgent' (to be seen within 30 minutes). With a decrease in the urgency of triage categories, the proportion admitted within 8 hours decreased dramatically and the proportion of formal discharge increased. Notably, 45% of transient ischaemic attacks (TIAs) were categorized as 'Semi-urgent' (to be attended within 60 minutes), indicating an opportunity to improve emergency assessment of TIAs. The results illustrate the utility of hospital administrative data and the applicability of BNs for review of the current triage practices and subsequent impact.
 
Article
Mobile applications or 'apps' have significant potential for use in mental health interventions with adolescents. However, there is a lack of research exploring end users' needs from such technologies. The aim of this study was to explore adolescents' needs and concerns in relation to mental health mobile apps. Five focus groups were conducted with young people aged 15-16 years (N = 34, 60% male). Participants were asked about their views in relation to the use of mental health mobile technologies and were asked to give their responses to a mental health app prototype. Participants identified (1) safety, (2) engagement, (3) functionality, (4) social interaction, (5) awareness, (6) accessibility, (7) gender and (8) young people in control as important factors. Understanding end users' needs and concerns in relation to this topic will inform the future development of youth-oriented mental health apps that are acceptable to young people.
 
Article
This study aims to understand IT investment decisions from the perspective of senior health system executives. A two-stage study was used to investigate this highly influential, very specialized and small population of interest. The first stage involved qualitative interviews with top health executives and analysed their opinions and beliefs using an innovation diffusion theory framework. The second stage involved quantitative surveys of senior health executives to gain an understanding of their opinions regarding the organizational and technological drivers (the independent variables) and the level of IT adoption (the dependent variable). It was found that the majority of drivers identified as being significant to organizational and technological innovation are degraded in respect to IT and health. It was concluded that health executives hold a range of views that potentially inhibit the increased adoption of IT in health. In particular, beliefs about the technology itself have been identified as the most influential deterrents.
 
Article
The study attempts to unify prior research and develop a comprehensive, empirically based conceptual model of the barriers to EHR adoption among community physicians. The model uses concept mapping, which taps the shared expertise of a group and provides reliable estimates with relatively small sample sizes. The methodology includes brainstorming of barrier statements and sorting and rating of issue statements. The model illuminates the larger structure of barriers as well as the finer details of constituent issues. Core issues are standardization and interoperability; also important are technical issues and the cost-benefit of adopting EHRs. However, psychosocial issues, the main focus of diffusion research, seem relatively peripheral. We believe the development of this model is an important first step in creating effective and measurable interventions that enhance the adoption of EHRs in healthcare.
 
Article
While much research focuses on adoption of electronic health-care records and other information technology among health-care providers, less research explores patient attitudes. This qualitative study examines barriers to adoption of home-based health information technology, particularly personal electronic health records, among older adults. We conducted in-depth interviews (30-90 min duration) with 35 American adults, aged 46-72 years, to determine their perceptions of and attitudes toward home-based health information technology. Analysis of interview data revealed that most barriers to adoption fell under four themes: technological discomfort, privacy or security concerns, lack of relative advantage, and perceived distance from the user representation. Based on our findings, systems to promote home-based health information technology should incorporate familiar computer applications, alleviate privacy and security concerns, and align with older adults' active and engaged self-image.
 
Article
The purpose of this study was to assess reproductive health professionals' familiarity with and use of various electronic technologies to support health promotion. The study also examined the relationship between demographic characteristics and attitudes and beliefs of the effectiveness of new technologies and perceived barriers for usage. A total of 165 reproductive health professionals at two conferences related to reproductive health in the United States completed the study survey. Personal and organizational factors affected the adoption of electronic technologies for health promotion. This included lack of knowledge, skills, and confidence as well as privacy concerns. The results of the study also suggested that being from an older generation was associated with having lower levels of knowledge, skills, and confidence in using new media. These findings highlight the importance of creating learning opportunities on the use of new technology for health promotion as well as addressing specific perceived barriers among reproductive health professionals in order to promote the adoption of these technologies. © The Author(s) 2013.
 
Article
Managing patients' length of stay is a critical task for healthcare organizations. In order to better manage the processes impacting this performance metric, providers can leverage data resources describing the network of activities that impact a patient's stay with analytic methods. Interdependencies between departmental activities exist within the patient treatment process, where inefficiency in one element of the patient care network of activities can adversely affect process outcomes.This work utilizes the method of neural networks to analyze data describing inpatient cases that incorporate radiology process variables to determine their effect on patient length of stay excesses for a major NJ based healthcare provider. The results indicate that inefficiencies at the radiology level can adversely extend a patient's length of stay beyond initial estimations. Proactive analysis of networks of activities in the patient treatment process can enhance organizational efficiencies of healthcare providers by enabling decision makers to better optimize resource allocations to increase throughput of activities.
 
Website inclusion and exclusion criteria 
Flow diagram of identification and retention of sites for review 
Article
Falls among older people are a major public health issue. Increasing numbers of older people are accessing the internet for health-related information, including information on falls risk and prevention. However, we are aware of no study that has assessed the quality of such websites. Using techniques for conducting systematic literature reviews, we evaluated English-language websites offering falls-related advice to members of the public. Forty-two websites were identified using popular search engines; these were assessed using evidence-based guidelines and codes of conduct on coverage of falls-related information, credibility and senior friendliness. Overall, scores were poor for coverage of falls information and credibility, although they were higher for senior friendliness. Few of the websites had been recently updated and none provided individually-tailored advice. We conclude that websites have fallen short of their potential to provide accessible, evidence-based information on the risks of falls and their prevention.
 
Splash page of the self-help application.  
Article
Technology-based self-help interventions have the potential to increase access to evidence-based mental healthcare, especially for families affected by natural disasters. However, development of these interventions is a complex process and poses unique challenges. Usability testing, which assesses the ability of individuals to use an application successfully, can have a significant impact on the quality of a self-help intervention. This article describes (a) the development of a novel web-based multi-module self-help intervention for disaster-affected adolescents and their parents and (b) a mixed-methods formal usability study to evaluate user response. A total of 24 adolescents were observed, videotaped, and interviewed as they used the depressed mood component of the self-help intervention. Quantitative results indicated an above-average user experience, and qualitative analysis identified 120 unique usability issues. We discuss the challenges of developing self-help applications, including design considerations and the value of usability testing in technology-based interventions, as well as our plan for widespread dissemination. © The Author(s) 2015.
 
Article
Patient care based on best available evidence is increasingly viewed as the hallmark of good quality medical diagnosis and treatment, yet its uptake is often slow and uneven and the reasons underlying the slow diffusion of evidence-based guidelines remain elusive. The authors report a qualitative study conducted at a major US teaching hospital which sought to discover the reasons why an evidence-based anticoagulation guideline appeared to be applied irregularly, with problematic results. Using a theoretical framework derived from Rogers' work on the diffusion of innovation, this article describes the ways in which a group of residents evaluated and applied evidence in the context of caring for their patients. Future work in evidence-based practice can benefit from a greater emphasis on studies that use multi-method, qualitative designs to explore the complex ways in which people interact with information and the changes that ensue from its use.
 
Framework for continued research in health information systems 
Topics in e-health and clinical systems 
Topics in personal health and independent living 
General topics in health information systems 
Article
The main aim of this article is to present a research agenda and systematic framework of what the field of health information systems is about, namely its central topics and connecting areas. In doing so, we try to provide a cohesive 'big picture' for academics and professionals that are interested in conducting research in this broad area. By using a large number of disparate data sources, we identified 3 major research fields and 18 sub-fields. As this discipline is quite new and heterogeneous in terms of themes and the educational backgrounds of its researchers, we see our conceptualisation as a first step in obtaining a collective understanding of this field, as well as being a common starting point for discussing future directions.
 
Article
Issues in epidemiology are truly multidisciplinary, requiring knowledge from diverse disciplines such as sociology, medicine, biology, geography and information science. Such inherent complexity has led to a challenge in developing decision support systems for epidemic information management, especially when data are from heterogeneous origins. In order to achieve a solution, an integrative framework is proposed. The Semantic Web is introduced in the context of enriching meaningful and machine-readable descriptions of epidemiological data. Software agents are utilised to achieve automation in semantic discovery, composition of data and process services. The objective is to enhance the performance in information retrieval in a dynamic decision-making environment while concealing technical complexity from inexperienced users. We illustrate how a prototype system can be developed by considering an epidemiology management scenario in which spatio-temporal analysis is undertaken of a specified epidemic.
 
Article
The rise of electronic medical records promotes the collection and aggregation of medical data. These data have tremendous potential utility for health policy and public health; yet there are gaps in the scholarly literature. No articles in the medical or legal literature have mapped the "information flows" from patient to database, and commentary has focused more on privacy than on data's social value and incentives for production. Utilizing short case studies of data flows, I show that ample data exist, much of them are available online through government websites or hospital trade associations. However, available information comes from billing records rather than medical records. Turning to legal and policy recommendations for better provision, I note that weak intellectual property law has ironically led to stronger control over health data through private contracts and technological barriers, as these methods of protection lack any exceptions for noncommercial use. I conclude with a series of policy proposals to make data more available.
 
Top-cited authors
Joseph Cafazzo
  • University Health Network
Emily Seto
  • University of Toronto
Fadi Thabtah
  • DementiaTests
Lisa Sharp
  • University of Illinois at Chicago
Melinda R Stolley
  • Medical College of Wisconsin