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Background: The adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption.Objective: We aim to assess the proportion of physicians who are routinely working with electronic health data and describe to what extent physicians exchange electronic health data with peers and other health care providers. Additionally, we aim to estimate the effect of physicians' attitude towards health IT on the adoption of electronic workflows.Methods: Between May and July 2013, we conducted a cross-sectional survey of 1200 practice based physicians in Switzerland. Respondents were asked to report on their technical means and where applicable their paper-based workarounds to process laboratory data, examination results, referral letters and physician's letters. Physicians' view of barriers and facilitators towards health IT use was determined by a composite score.Results: A response rate of 57.1% (n=685) was reached. The sample was considered to be representative for physicians in Swiss ambulatory care. 35.2% of the respondents documented patients' health status with the help of a longitudinal semi-structured electronic text record generated by one or more encounters in the practice. Depending on the task within a workflow, around 11-46% of the respondents stated to rely on electronic workflow practices to process laboratory and examination data and dispatch referral notes and physician's letters. The permanent use of electronic workflow processes was infrequent. Instead, respondents reported paper-based workarounds affecting specific tasks within a workflow. Physicians' attitude towards health IT was significantly associated with the adoption of electronic workflows (OR 1.04-1.31, p<0.05), but the effect sizes of factors related to the working environment (e.g., regional factors, medical specialty, type of practice) were larger.Conclusion: At present, only a few physicians in Swiss ambulatory care routinely work with electronic health data. Until more of their peers participate in electronic exchange of structured clinical information, most physicians will continue to stay in paper-based systems and workarounds. The survey found that physicians with a positive attitude towards health IT were more likely to adopt electronic workflows, but the impact is minor. It will likely be necessary to introduce financial incentives and develop national standards in order to promote the adoption by a critical mass of practicing clinicians. [ABSTRACT FROM AUTHOR]

In complex organizational choices with consequences spread all over the organization, good management practice recommends the auscultation of the points of view of people from different operational areas, to inform a final decision-making body. In large corporations such an internal participatory process may easily involve a large number of people, however time and scheduling constraints are not compatible with gathering them together in presential meetings to reach an alignment around key decision objectives. One of these cases was the selection of a new Enterprise Management System (EMS) for GALP ENERGIA (a Portuguese energy company). The aim of this paper is to report on how a socio-technical process was designed and took place under the "Collaborative Value Modelling" framework, combining technical elements of the MACBETH multicriteria evaluation method with two social settings: firstly, Web-Delphi to elicit individual qualitative judgements from a large number of collaborators from the different departments of GALP ENERGIA; followed by a Decision Conference where a small steering committee used the knowledge collected in the Delphi to inform the construction of a quantitative model to compare the EMS alternatives proposed by information technology companies. To detail our rationale, we focus on the qualitative swing-weighting questioning MACBETH mode, implemented in the Welphi information technology platform in which GALP collaborators provided individual weighting judgements, and then in the decision conferencing for final weighting of criteria by the steering committee. The main contribution of this paper is on detailing how, through the "Collaborative Value Modeling" framework, it is possible to promote "dialogue" among a large group of participants in a corporate setting, therefore promoting alignment and increasing model acceptance within the company. [ABSTRACT FROM AUTHOR]

Purpose: Cognition elaboration cues play critical roles in the innovation diffusion process of Internet innovative products. This paper aims to theorize and examine how central cognition elaboration cue and peripheral cognition elaboration cue impact users' continuance intention of mobile health applications in the context of the developing markets.Design/methodology/approach: Applying the elaboration likelihood model as the basic theoretical framework, this paper proposed the hypotheses and research model to explore the internal formation mechanism of users' continuance intention of mobile health applications. And the moderating effect of privacy concern was especially studied under the context of the developing market. The empirical investigation (N = 284) collects research data through questionnaire by selecting a certain mobile health application from Chinese markets.Findings: The results show that, both perceived usefulness and trust positively affect users' continuance intention. For central route, doctor's service quality and doctor's information quality positively influence perceived usefulness. For peripheral route, app's reputation and app's institution assurance significantly promote users' trust. What's more, for the moderating effect, privacy concern can enhance the impact of perceived usefulness on continuance intention and strengthen the effect of trust on continuance intention to a great extent.Originality/value: This paper is one of the first studies to focus on users' continuance intention of mobile health apps with the moderating effect of privacy concern in the developing markets. It is valuable to develop the study from the perspective of process-oriented to persuasion to explore users' behavioral intention. [ABSTRACT FROM AUTHOR]

Purpose There is limited application and evaluation of health information systems in the management of vaso-occlusive pain crises in sickle cell disease (SCD) patients. This study evaluates the impact of digitization of paper-based individualized pain plans on process efficiency and care quality by examining both objective patient data and subjective clinician insights. Methods Retrospective, before and after, mixed methods evaluation of digitization of paper documents in Children's Hospital of Pittsburgh of UPMC. Subjective perceptions are analyzed using surveys completed by 115 clinicians in emergency department (ED) and inpatient units (IP). Objective effects are evaluated using mixed models with data on 1089 ED visits collected via electronic chart review 28 months before and 22 months after the digitization. Results Surveys indicate that all clinicians perceived the digitization to improve the efficiency and quality of pain management. Physicians overwhelmingly preferred using the digitized plans, but only 44% of the nurses had the same response. Analysis of patient records indicates that adjusted time from analgesic order to administration was significantly reduced from 35.50 to 26.77 min ( p < .05). However, time to first dose and some of the objective quality measures (time from administration to relief, relief rate, admission rate, and ED re-visit rate) were not significantly affected. Discussion The relatively simple intervention, high baseline performance, and limited accommodation of nurses’ perspectives may account for the marginal improvements in process efficiency and quality outcomes. Additional efforts, particularly improved communication between physicians and nurses, are needed to further enhance quality of pain management. Conclusion This study highlights the important role of health information technology (HIT) on vaso-occlusive pain management for pediatric patients with sickle cell disease and the critical challenges in accommodating human factor considerations in implementing and evaluating HIT effects. [ABSTRACT FROM AUTHOR]

Care coordination is important for chronically ill patients who need assistance from a variety of healthcare professionals especially when they transition through different care settings. There has not been a clear definition of care coordination and its associated activities. This paper provides a two-dimension framework of care coordination for chronically ill patients: 1) coordination activities (i.e. communication and monitoring) and 2) interdependencies (i.e. flow, shared resources, simultaneity). We used this framework in a qualitative content analysis of 12 interviews with healthcare professionals involved in coordinating care of chronically ill patients. We identified a total of 258 care coordination activities and developed categories and sub-categories using the constant comparative method. The first category of care coordination activities involves communication with flow or shared resources interdependencies or both. This category includes arranging services and equipment for the patient, exchanging information about patient transition to different care settings, reporting errors and resolving them, and helping the patient with appointments and transportation. The second category involves monitoring, sometimes combined with communication, with flow or shared resources interdependencies or both. This category includes reviewing medications and services and detecting errors, reviewing patient symptoms and following up if needed, and scheduling follow-up to review patient status. The last category involves communication with simultaneity interdependency. This category involves talking in the same location and developing a plan of care, people exchanging information at the same time, and scheduling delivery of medications/services to correspond with patient arrival home. Finally, we identified characteristics of health information technology that can support these various care coordination activities. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to identify and describe the cognitive requirements and associated information needs of referring primary care providers (PCPs) during the referral process as well as characterize referring PCPs' experiences with current health information technology.Materials and Methods: We interviewed 62 referring PCPs. Our four-member analysis team used hierarchical task analysis to construct a goal-directed hierarchy. We utilized extensions of the task analysis to describe PCPs' common experiences with health information technologies throughout the referral process.Results: The resultant goal hierarchy includes one main goal (Referral for Additional Care), two sub-goals (Assess Patient's Condition and Manage Referrals), and four major tasks with respective decisions (What consultation is warranted; What information should I provide; What additional action is needed; and How to integrate specialists' findings). Approximately 22 information needs were commonly identified and PCPs described their use of various sources - other PCPs, electronic health records, chat software, and paper- to satisfy those information needs.Conclusion: Cognitive demand for referring PCPs is high throughout the referral process. They have to search, identify, compose, track, and integrate information across multiple screens, systems, and people. Existing interfaces do not adequately support the communication, information exchange, or care coordination related to the referral process. Results from this study provide an important foundation for developing patient-centered displays that support PCPs' decision-making process and reduce cognitive challenges. [ABSTRACT FROM AUTHOR]

Abstract: This paper summarises some of the research that Ken Eason and colleagues at Loughborough University have carried out in the last few years on the introduction of Health Information Technologies (HIT) within the UK National Health Service (NHS). In particular, the paper focuses on three examples which illustrate aspects of the introduction of HIT within the NHS and the role played by the UK National Programme for Information Technology (NPfIT). The studies focus on stages of planning and preparation, implementation and use, adaptation and evolution of HIT (e.g., electronic patient records, virtual wards) within primary, secondary and community care settings. Our findings point to a number of common themes which characterise the use of these systems. These include tensions between national and local strategies for implementing HIT and poor fit between healthcare work systems and the design of HIT. The findings are discussed in the light of other large-scale, national attempts to introduce similar technologies, as well as drawing out a set of wider lessons learnt from the NPfIT programme based on Ken Eason's earlier work and other research on the implementation of large-scale HIT. [Copyright &y& Elsevier]

Objective: The aim of this study was to examine eye gaze patterns between patients and physicians while electronic health records were used to support patient care.Background: Eye gaze provides an indication of physician attention to patient, patient/physician interaction, and physician behaviors such as searching for information and documenting information.Methods: A field study was conducted where 100 patient visits were observed and video recorded in a primary care clinic. Videos were then coded for gaze behaviors where patients' and physicians' gaze at each other and artifacts such as electronic health records were coded using a pre-established objective coding scheme. Gaze data were then analyzed using lag sequential methods.Results: Results showed that there are several eye gaze patterns significantly dependent to each other. All doctor-initiated gaze patterns were followed by patient gaze patterns. Some patient-initiated gaze patterns were also followed by doctor gaze patterns significantly unlike the findings in previous studies. Health information technology appears to contribute to some of the new significant patterns that have emerged. Differences were also found in gaze patterns related to technology that differ from patterns identified in studies with paper charts. Several sequences related to patient-doctor-technology were also significant. Electronic health records affect the patient-physician eye contact dynamic differently than paper charts.Conclusion: This study identified several patterns of patient-physician interaction with electronic health record systems. Consistent with previous studies, physician initiated gaze is an important driver of the interactions between patient and physician and patient and technology. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of the study was to understand the preparations for the introduction of electronic patient record systems (EPRs) within the outpatient services department of a large acute hospital based in the UK. In particular, one of the main aims of the study was to examine in detail the likely impact of EPRs on the working practices of healthcare workers, their expectations regarding the impact of EPRs within the department and other sociotechnical aspects of the management of patient information. Methods: Twenty-seven semi-structured interviews were undertaken with staff in a variety of roles that deal with the management of medical records. The interviews focused on the organisation of the medical records department and current problems (e.g., missing records). In addition, the interviews contained questions about the specific role of medical records supervisors in the administration of records, as well as pathways and expectations about EPRs more generally. The data from the interviews was analysed using a mixture of thematic and template analysis and coded using constructs from a sociotechnical model of information system implementation and adoption. Results: The findings show that despite severe delays to the nationally led (NPfIT) roll-out of EPRs and associated IT infrastructure within the UK, staff attitudes within the department were broadly positive about the potential of future EPRs to deliver efficiencies (e.g., improved workflow within the department, reduced reliance on paper-based systems). One of the main influences on attitudes towards the type of EPRs that should exist within outpatients was prompted by negative reactions to the way in which NPfIT systems had been managed and attempted to be introduced in the past. A strong commitment to end-user involvement in EPRs design, together with a rejection of NPfIT, appears to have shaped attitudes towards future expectations of the adoption of new EPRs within the department. In addition, staff do not believe that a rapid change to ‘paperless’ working is likely to be possible. Conclusions: Our findings provide further evidence that there is a need to treat the implementation of EPRs not simply as an exercise in technical system delivery, but as a larger process of sociotechnical systems change. We conclude the paper with some guidelines, the aim of which is to provide guidance regarding EPRs implementation and adoption informed by sociotechnical principles and ideas. [Copyright &y& Elsevier]

Today, people exhibit an increasing interest in using consumer-grade electronics and third-party services to proactively manage their health and wellbeing. Notably consumer wearables for health-related use grow in popularity. Despite this trend, it remains unclear how to effectively integrate this class of devices into existing healthcare infrastructures. In this work-in-progress research project, I am interested in how a new health-related technology is being embedded into the existing institutional context of the healthcare system existing in the Czech Republic. Here, I briefly report on an interesting initiative that creates an amalgamation of consumer health wearables with the existing telemedicine infrastructure. In June 2019, a niche Czech insurance company introduced a non-prescribed ECG teleconsultation service. The service can be used for free on a per-need basis by the clients with an approved consumer health wearable (currently, only Apple Watch 4 Series is supported). Drawing upon previous research in digital health and the social study of information technology, the paper lays out conceptual foundations and briefly discusses available anecdotal evidence that motivated this on-going research effort. The outcomes of this research are expected improve our understanding of the challenges related to healthcare digital transformation. [ABSTRACT FROM AUTHOR]

The recent advancement in Information and Communication Technology (ICT) has undoubtedly improved services in all sectors in the world. Specifically, Information Technology (IT) has led to a very vital innovation in health sector called electronic health (e-Health). In order to optimize full and excellent benefits of this innovation, its implementation in a cloud-based environment is important. However, with noticeable and numerous benefits inherent from e-Health in a cloud computing, its full utilization is still being hampered by challenges of security and privacy. In this paper, we focused on extensive review of current and existing literatures of various approaches and mechanisms being used to handle security and privacy related matters in e-Health. Strengths and weaknesses of some of these approaches were enunciated. The literature review was carried out after selecting over One Hundred and Ten (1 1 0) original articles and figured out several models adopted in their solutions. After comparing models used, we arrived at the reviewed articles. Reviewed articles were narrowed down to the current number because of similarity observed in the models adopted by some researchers. Also, we give an acceptable and standard definition of e-Health. Effort was made to classify cloud-based models. Security and privacy requirements as recommended by Health Insurance Portability and Accountability Act (HIPAA) were also discussed and provided. Remarks and recommendations were made regarding the review process and future directions on security and privacy of e-Health in cloud computing was also provided. Finally, authors propose a secured and dependable architecture for electronic health that could guarantee efficiency, reliability and regulated access framework to health information. The architecture, though is currently under implementation, will guarantee absolute security and privacy between healthcare providers and the patients. [ABSTRACT FROM AUTHOR]

Abstract Railway automatics systems have a significant impact on ensuring an adequate level of safety. Therefore, it is very important to strive to achieve the high reliability of these systems. Modern railway automatics systems commonly use information technologies that enable events logging and self-diagnostics. However, there are no standards in the field of data acquisition mechanisms and their analysis, which results that manufacturers of railway automatics systems apply various solutions in this regard. The problem of unifying diagnostic methods, and the way for data representation and their analysis is very important, as it can significantly facilitate building of modern diagnostic centers. In the paper the Bayesian inference and SNMP technology, as a tool to solve diagnostic and unifying problems, were presented. [ABSTRACT FROM AUTHOR]

Introduction: Laboratory testing in primary care is a fundamental process that supports patient management and care. Any breakdown in the process may alter clinical information gathering and decision-making activities and can lead to medical errors and potential adverse outcomes for patients. Various information technologies are being used in primary care with the goal to support the process, maximize patient benefits and reduce medical errors. However, the overall impact of health information technologies on laboratory testing processes has not been evaluated.Objectives: To synthesize the positive and negative impacts resulting from the use of health information technology in each phase of the laboratory 'total testing process' in primary care.Methods: We conducted a systematic review. Databases including Medline, PubMed, CINAHL, Web of Science and Google Scholar were searched. Studies eligible for inclusion reported empirical data on: 1) the use of a specific IT system, 2) the impacts of the systems to support the laboratory testing process, and were conducted in 3) primary care settings (including ambulatory care and primary care offices). Our final sample consisted of 22 empirical studies which were mapped to a framework that outlines the phases of the laboratory total testing process, focusing on phases where medical errors may occur.Results: Health information technology systems support several phases of the laboratory testing process, from ordering the test to following-up with patients. This is a growing field of research with most studies focusing on the use of information technology during the final phases of the laboratory total testing process. The findings were largely positive. Positive impacts included easier access to test results by primary care providers, reduced turnaround times, and increased prescribed tests based on best practice guidelines. Negative impacts were reported in several studies: paper-based processes employed in parallel to the electronic process increased the potential for medical errors due to clinicians' cognitive overload; systems deemed not reliable or user-friendly hampered clinicians' performance; and organizational issues arose when results tracking relied on the prescribers' memory.Discussion: The potential of health information technology lies not only in the exchange of health information, but also in knowledge sharing among clinicians. This review has underscored the important role played by cognitive factors, which are critical in the clinician's decision-making, the selection of the most appropriate tests, correct interpretation of the results and efficient interventions.Conclusions: By providing the right information, at the right time to the right clinician, many IT solutions adequately support the laboratory testing process and help primary care clinicians make better decisions. However, several technological and organizational barriers require more attention to fully support the highly fragmented and error-prone process of laboratory testing. [ABSTRACT FROM AUTHOR]

Background: Information technologies have been vital during the COVID-19 pandemic. Telehealth and telemedicine services, especially, fulfilled their promise by allowing patients to receive advice and care at a distance, making it safer for all concerned. Over the preceding years, professional societies, governments, and scholars examined ethical, legal, and social issues (ELSI) related to telemedicine and telehealth. Primary concerns evident from reviewing this literature have been quality of care, access, consent, and privacy.Objectives: To identify and summarize ethical, legal, and social issues related to information technology in healthcare, as exemplified by telehealth and telemedicine. To expand on prior analyses and address gaps illuminated by the COVID-19 experience. To propose future research directions.Methods: Literature was identified through searches, forward and backward citation chaining, and the author's knowledge of scholars and works in the area. EU and professional organizations' guidelines, and nineteen scholarly papers were examined and categories created to identify ethical, legal, and social issues they addressed. A synthesis matrix was developed to categorize issues addressed by each source.Results: A synthesis matrix was developed and issues categorized as: quality of care, consent and autonomy, access to care and technology, legal and regulatory, clinician responsibilities, patient responsibilities, changed relationships, commercialization, policy, information needs, and evaluation, with subcategories that fleshed out each category. The literature primarily addressed quality of care, access, consent, and privacy. Other identified considerations were little discussed. These and newer concerns include: usability, tailoring services to each patient, curriculum and training, implementation, commercialization, and licensing and liability. The need for interoperability, data availability, cybersecurity, and informatics infrastructure also is more apparent. These issues are applicable to other information technologies in healthcare.Conclusions: Clinicians and organizations need updated guidelines for ethical use of telemedicine and telehealth care, and decision- and policy-makers need evidence to inform decisions. The variety of newly implemented telemedicine services is an on-going natural experiment presenting an unparalleled opportunity to develop an evidence-based way forward. The paper recommends evaluation using an applied ethics, context-sensitive approach that explores interactions among multiple factors and considerations. It suggests evaluation questions to investigate ethical, social, and legal issues through multi-method, sociotechnical, interpretive and ethnographic, and interactionist evaluation approaches. Such evaluation can help telehealth, and other information technologies, be integrated into healthcare ethically and effectively. [ABSTRACT FROM AUTHOR]

Background: Evaluation of health information systems (HISs) is complicated because of the complex nature of the health care domain. Various studies have proposed different frameworks to reduce the complexity in the assessment of these systems. The aim of these frameworks is to provide a set of guidelines for the evaluation of the adequacy of health care information systems.Objective: This paper aims to analyse studies on the evaluation of HISs by applying a content, context and process (CCP) framework to address the 'who', 'what', 'how', 'when', and 'why' of the evaluation processes used. This will allow for a better understanding of the relative strengths and weaknesses of various HISs evaluation frameworks, and will pave the way for developing a more complete framework for HISs.Method: A systematic literature review on HIS evaluation studies was undertaken to identify the currently available HIS evaluation frameworks. Five academic databases were selected to conduct this systematic literature review.Results: Most of the studies only address some, but not all, of the five main questions, i.e. the who, what, how, when, why, and that there was a lack of consensus in the way these questions were addressed. The critical role of context was also largely neglected in these studies.Conclusions: Evaluation of HISs is complex. The health care domain is highly context sensitive and in order to have a complete assessment of HISs, consideration of contextual factors is necessary. Specifically, to have the right set of criteria to measure the 'what', the answer to the 'who' of the evaluation is necessary. [ABSTRACT FROM AUTHOR]

• Three fundamental IT affordances in an organization, namely collaborative affordance, organizational memory affordance, and process management affordance are considered. • These affordances harmonically coalign to produce the overall harmonic IT affordance (HITA) of the organization. • HITA is actualized by organizational courage to produce two forms of innovation: exploratory and exploitative. • The effect of actualized HITA is higher on exploratory innovation than exploitative innovation. • Exploitative innovation leads to exploratory innovation. • Two studies, one in US and the other in China lend support for our theory. Researchers and practitioners have long believed that information technology (IT) is a key tool for fostering innovation. However, there is a certain inconsistency in the literature, which makes it challenging for researchers to figure out exactly how and why IT plays such a pivotal, strategic organizational role. The motivation for this research is the multiple contradictory results reported by studies investigating the influence of information technology (IT) on organizational innovation. This study utilizes a fit-based perspective in an attempt to disentangle these contradictions. Using Venkatraman's (1989) seminal paper on fit, we conceive of two critical fit-based concepts: harmonious IT affordance in an organization (HITA) and a subsequent fit between HITA and organizational courage. HITA reflects a covariance fit (coalignment) between the three major IT affordances in an organization—collaborative affordance, organizational memory affordance, and process management affordance. Organizational courage reflects the boldness (risk-taking ability) of the organization. Finally, HITA and organizational courage represent a matching fit (reflected as actualized HITA) that influences two kinds of innovation: exploratory and exploitative. Two studies, conducted in the US and Chinese contexts, provide support for this theory. The main contribution of the paper is in showing that IT can lead to innovation if (a) organizational IT affordances harmoniously coalign (as HITA); (b) and, organizational courage acts as a powerful contingency that actualizes HITA, and this actualized HITA influences innovation. [ABSTRACT FROM AUTHOR]

Objective: To review evidence of the effectiveness of information technology (IT) interventions to improve antimicrobial prescribing in hospitals.Method: MEDLINE (1950-March 2015), EMBASE (1947-March 2015) and PubMED (1966-March 2015) were searched for studies where an IT intervention involving any device (e.g. computer, mobile phone) was evaluated in practice. All papers were assessed for quality using a 10-point rating scale.Results: We identified 45 articles that evaluated an IT intervention to improve antimicrobial prescribing in hospitals. IT interventions took four main forms: (1) stand-alone computerized decision support systems (CDSSs), (2) decision support embedded within a hospital's electronic medical record (EMR) or computerized provider order entry (CPOE) system, (3) computerized antimicrobial approval systems (cAAS), and (4) surveillance systems (SSs). Results reported allowed us to perform meta-analyses for three outcome measures: appropriate use of antimicrobials, patient mortality and hospital length of stay (LOS). IT interventions increased appropriate use of antimicrobials (pooled RR: 1.49, 95%CI: 1.07-2.08); however no evidence of an effect was found when analysis included only studies with a quality score of five or above on the 10-point quality scale (pooled RR: 1.53, 95%CI: 0.96-2.44). There was little evidence of an effect of IT interventions on patient mortality or LOS. The range of study designs and outcome measures prevented meaningful comparisons between different IT intervention types to be made.Conclusion: IT interventions can improve the appropriateness of antimicrobial prescribing. However, high quality, systematic multi-site comparative studies are critically needed to assist organizations in making informed decisions about the most effective IT interventions. [ABSTRACT FROM AUTHOR]

Objectives: The Renal PatientView (RPV) website is an information and education tool aimed at increasing patient involvement in their care. We have conducted this study to elucidate why some users remain inactive on RPV despite initially signing up for the service.Methods: Patients at a teaching hospital in United Kingdom, who originally signed up for RPV but are no longer active (no logins during previous 6 months), were sent paper questionnaires. Responses were collected for up to 6 months.Results: Of the 190 questionnaires, 69 (39%) were returned partially or fully completed. Majority of respondents could access computer (94%) and internet (91%) from home. Reasons for inactivity among survey respondents included: loss of login credentials (45%), perception that it did not add anything to existing care (37%), being too busy (13%) and anxiety of viewing results from home (10%). Thirty-seven respondents provided free-text comments. Thematic analysis of these reinforced above findings and also indicated that despite infrequent use, some patients valued RPV availability. Patients made very little reference to using sections of the website other than test results.Conclusions: Patients find RPV a valuable resource. It is, however, mainly seen as a portal to check blood test results; other sections of the website aimed at promoting self-management remain underutilized. Several local and central level changes, such as a robust system of user accounts handling, improved promotion, and emphasis on further development of self-management sections of RPV may help improve participation. [ABSTRACT FROM AUTHOR]

Objective: The diagnosis of Alzheimer's disease (AD) remains difficult. Lack of diagnostic certainty or possible distress related to a positive result from diagnostic testing could limit the application of new testing technologies. The objective of this paper is to quantify respondents' preferences for obtaining AD diagnostic tests and to estimate the perceived value of AD test information.Methods: Discrete-choice experiment and contingent-valuation questions were administered to respondents in Germany and the United Kingdom. Choice data were analyzed by using random-parameters logit. A probit model characterized respondents who were not willing to take a test.Results: Most respondents indicated a positive value for AD diagnostic test information. Respondents who indicated an interest in testing preferred brain imaging without the use of radioactive markers. German respondents had relatively lower money-equivalent values for test features compared with respondents in the United Kingdom.Conclusions: Respondents preferred less invasive diagnostic procedures and tests with higher accuracy and expressed a willingness to pay up to €700 to receive a less invasive test with the highest accuracy. [ABSTRACT FROM AUTHOR]

Objective: This paper aims at developing an automated gastroscopic video summarization algorithm to assist clinicians to more effectively go through the abnormal contents of the video.Methods and Materials: To select the most representative frames from the original video sequence, we formulate the problem of gastroscopic video summarization as a dictionary selection issue. Different from the traditional dictionary selection methods, which take into account only the number and reconstruction ability of selected key frames, our model introduces the similar-inhibition constraint to reinforce the diversity of selected key frames. We calculate the attention cost by merging both gaze and content change into a prior cue to help select the frames with more high-level semantic information. Moreover, we adopt an image quality evaluation process to eliminate the interference of the poor quality images and a segmentation process to reduce the computational complexity.Results: For experiments, we build a new gastroscopic video dataset captured from 30 volunteers with more than 400k images and compare our method with the state-of-the-arts using the content consistency, index consistency and content-index consistency with the ground truth. Compared with all competitors, our method obtains the best results in 23 of 30 videos evaluated based on content consistency, 24 of 30 videos evaluated based on index consistency and all videos evaluated based on content-index consistency.Conclusions: For gastroscopic video summarization, we propose an automated annotation method via similar-inhibition dictionary selection. Our model can achieve better performance compared with other state-of-the-art models and supplies more suitable key frames for diagnosis. The developed algorithm can be automatically adapted to various real applications, such as the training of young clinicians, computer-aided diagnosis or medical report generation. [ABSTRACT FROM AUTHOR]

Objectives: This paper provides a systematic review of safety use of health information technology (IT). The first objective is to identify the antecedents towards safety use of health IT by conducting systematic literature review (SLR). The second objective is to classify the identified antecedents based on the work system in Systems Engineering Initiative for Patient Safety (SEIPS) model and an extension of DeLone and McLean (D&M) information system (IS) success model.Methods: A systematic literature review (SLR) was conducted from peer-reviewed scholarly publications between January 2000 and July 2014. SLR was carried out and reported based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The related articles were identified by searching the articles published in Science Direct, Medline, EMBASE, and CINAHL databases. Data extracted from the resultant studies included are to be analysed based on the work system in Systems Engineering Initiative for Patient Safety (SEIPS) model, and also from the extended DeLone and McLean (D&M) information system (IS) success model.Results: 55 articles delineated to be antecedents that influenced the safety use of health IT were included for review. Antecedents were identified and then classified into five key categories. The categories are (1) person, (2) technology, (3) tasks, (4) organization, and (5) environment. Specifically, person is attributed by competence while technology is associated to system quality, information quality, and service quality. Tasks are attributed by task-related stressor. Organisation is related to training, organisation resources, and teamwork. Lastly, environment is attributed by physical layout, and noise.Conclusions: This review provides evidence that the antecedents for safety use of health IT originated from both social and technical aspects. However, inappropriate health IT usage potentially increases the incidence of errors and produces new safety risks. The review cautions future implementation and adoption of health IT to carefully consider the complex interactions between social and technical elements propound in healthcare settings. [ABSTRACT FROM AUTHOR]

Background Use of patient portals may contribute to improved patient health and experiences and better organizational performance. In the Netherlands, patient portals have gained considerable attention in recent years, as evidenced by various policy initiatives and practical efforts directed at developing portals. Due to the fragmented setup of the Dutch healthcare system patient portals that give patients access to information and services from across their providers are developed in inter-organizational collaboration. Objective The objective of this paper is to identify and describe the types of collaborations, or networks, that have been established to develop patient portals in the Netherlands. Understanding the characteristics of these networks as well as the development of their respective portals enables us to assess the enabling and constraining effects of different network types on patient portal initiatives. Methods We used qualitative methods including interview and documents analysis. In a first step, we interviewed eighteen experts and reviewed relevant national policy and strategy documents. Based on this orientation, we selected three networks we deemed to be representative of inter-organizational efforts to develop Dutch patient portals in 2012. In a second step, we interviewed twelve representatives of these patient portal networks and collected documents related to the portals. We applied content analytic techniques to analyze data from the three cases. Results The three studied networks differed in their number and diversity of actors, the degree to which these actors were mutually dependent, the degree to which network governance was decentralized, and the dynamics of the network structures. We observed that the portals developed in networks displaying the highest degree of these characteristics experienced most difficulties associated with developing patient portals – such as achieving interoperability, successful implementation, regulatory complaisance, and financial sustainability. Yet, at the same time, the portals developed in these networks may hold the highest functionality to patients, since they can consolidate information and services from a broad array of health service providers. Conclusions The early empirical evidence provided here indicates that effective development of patient portals begs a tradeoff between envisioned functionality and ease of development. [ABSTRACT FROM AUTHOR]

Health Information Technology (HIT) has the potential to improve the quality, efficiency, outcomes, patient safety and reduce the cost of healthcare. But HIT systems are not widely available, and even if available are not properly utilized. This paper reviewed some available HIT systems in order to have an idea on their availability. Also works on acceptance of HIT systems were reviewed so as to understand the level of research done in the area. The problems identified from this work include lack of availability of these systems especially in developing countries, insufficient works on user acceptance of HIT systems, etc. These limitations can be overcome when researchers study the factors that will affect the user acceptance of these systems, and then consider the factors while developing the systems. Finally, a conceptual model of HIT acceptance in developing countries is proposed. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Providing access to patient information is the key factor in nurses’ adoption of a Nursing Information System (NIS). In this study the requirements for information quality and the perceived quality of information are investigated. A teaching hospital in the Netherlands has developed a NIS as a module of the Hospital Information System. After the NIS was implemented in six wards in March 2009, the NIS was evaluated. Methods: A paper questionnaire was distributed among all 195 nurses, who used the system. Included in the research were 93 (48%) respondents. Also twelve NIS-users were interviewed, using the USE IT-model. Results: Nurses express a broad need for information of each patient. Although the history is essential, the information needs are not very specified. They expect complete, correct, up-to-date and accessible information of each patient. The information quality of the NIS is satisfactory, but needs improvement. Since the achieved quality of information depends largely on the data-entry by the nurses themselves, a controversy exists between the required information quality and the effort needed to accomplish this. Conclusions: The aspect of data-entry by the user of the information is not included in Information Quality-literature. To further increase the quality of information, a redesign of both process and system seems necessary, which reduces the information needs of nurses and rewards the nurse for accurate data-entry. [Copyright &y& Elsevier]

Abstract: Recent reports by major health institutions have shown that up to one half of patients do not take their medications as prescribed, which undermines treatment outcomes and increases the costs of healthcare. The implantation of Electronic Health Records (EHR) is seen as a key step in all the strategies envisaged to address this problem, and there are several major initiatives to standardize such artifacts. In this paper, we present a system that aims to promote medication adherence in contexts of daily life, interacting with standards-based EHR repositories from both domestic and mobile devices. This approach represents an advance with regard to previous works on smart medicine managers, which could only record information in local logs and required the users to enter their prescriptions and medications regimens manually. Experiments with real users confirm the added value of applications with automatic access to EHR and interfaces for various types of devices. [Copyright &y& Elsevier]

Abstract: Objectives: This literature review identifies and categorises, from an organisational management perspective, barriers to the use of HIT or ICT for health. Based on the review, it offers policy interventions. Methods: This systematic literature review was carried out during December 2009 and January 2010. Additional on-going reviews of updates through automated system alerts took place up until this paper was submitted. A total of thirty-one sources were searched including nine software platforms/databases, fifteen specialised websites/targeted databases, Google Scholar, ISI Science Citation Index and five journals hand-searched. Results: The study covers seventy-nine articles on organisational barriers to ICT adoption by healthcare professionals. These are categorised under five main headings – (I) Structure of healthcare organisations; (II) Tasks; (III) People policies; (IV) Incentives; and (V) Information and decision processes. A total of ten subcategories are also identified. By adopting an organisational management approach, some recommendations to remove organisational management barriers are made. Conclusions: Despite their apparent promise, health information technologies (HIT) have proved difficult to implement. This systematic review reveals the implementation barriers associated to organisational management and their interrelations. Several important future directions in the field are also suggested: (1) there is a need for further research providing evidence of HIT cost-effectiveness as well as the development of optimal HIT applications; (2) more information is needed regarding organisational change, incentives, liability issues, end-users HIT competences and skills, structure and work process issues involved in realising the benefits from HIT. Future policy interventions should consider the five dimensions identified when addressing the impact of HIT in healthcare organisational systems, and how the impact of an intervention aimed at a particular dimension would interrelate with others. [Copyright &y& Elsevier]

Abstract: Objective: Health information technology has been shown to influence the communication patterns of healthcare providers. The goal of this study was to learn more about how healthcare providers communicate and exchange patient clinical information during patient handoffs (transfers) between units in an acute care setting. Methods: Convenience sampling was used to select five patient handoffs. Questionnaires were distributed to providers identified through observation and snowball sampling. Social network analysis methodology was used to develop sociograms of the emergent communication patterns and identify the role of individual providers in the handoff process based on the number of contacts with other providers and incoming and outgoing communication activity. Individual handoff network size ranged from 11 to 20 providers. Participants were asked to describe the method of communication they used to access or share clinical information with other providers, their preferred method of communication; their satisfaction with the available options; and their suggestions for how the process could be improved. Results: The network patterns that emerged uncovered the overlapping use of synchronous and asynchronous communication methods (verbally via phone or in person; or written via paper charts and/or an electronic records). No particular professional group dominated or coordinated information flow; instead each handoff network exhibited unique communication patterns and information coordination by two or more influential providers from nursing, medicine, or pharmacy. Most (84%) participants preferred verbal communication. Overall satisfaction with the current communication process varied by unit: 82% of emergency department providers and 54% of the providers working in the admitting units stated they were satisfied or very satisfied. Recommendations for improvement included converting all units to the electronic health record, electronic handoff communication modules and asynchronous multi-professional communication logs. Conclusions: The results of this exploratory study provide a foundation for future research examining how network structure and communication principles can be used to design health information technology that compliments the non-linear information gathering and dissemination behaviors of providers from multiple professions. [Copyright &y& Elsevier]

Background: Lung transplantation is one of the advanced treatment options performed even in patients suffering from end-stage lung disease. Due to the positive results of medical informatics in other fields of medicine, lung transplant researchers have also conducted remarkable studies to improve transplant outcomes. The main objective of this article was to review the current studies of health information technology used in lung transplantation.Methods: A systematic search was performed in four scientific databases (Web of Science, Scopus, Science Direct, and PubMed) from January 2000 to December 2018. The criteria for inclusion were included in any study describing the use of health information technology or medical informatics in terms of lung transplantation, English papers, and original researchers. The retrieved articles were accordingly screened based on the inclusion and exclusion criteria to select relevant studies. The survey and synthesis of included articles were conducted based on predefined classification.Results: Out of 263 articles, 27 studies met our inclusion criteria. All included studies involved the application of health information technology in lung transplantation. The types of health information technology methods applied in reviewed articles included mhealth (11.1 %), DSS (7.4 %), decision aid tools (7.4 %), telemedicine (22.2 %), AI methods (11.1 %), data mining (37 %), and patient education (3.7 %). The majority of studies (88.9 %) showed the positive impact of health information technology to enhance lung transplantation outcomes. Finally, the main approaches in different phases of lung transplantation processes were interpreted and summarized in the visual model.Conclusion: This systematic review provides new insights regarding the application of medical informatics in the lung transplantation domain. The missing areas of medical informatics in the lung transplantation domain were recognized through this study. [ABSTRACT FROM AUTHOR]

Since the publication of "Health Information Technology: Fallacies and Sober Realities" in 2010, health information technology (HIT) has become nearly ubiquitous in US healthcare facilities. Yet, HIT has yet to achieve its putative benefits of higher quality, safer, and lower cost care. There has been variable but largely marginal progress at addressing the 12 HIT fallacies delineated in the original paper. Here, we revisit several of the original fallacies and add five new ones. These fallacies must be understood and addressed by all stakeholders for HIT to be a positive force in achieving the high value healthcare system the nation deserves. Foundational cognitive and human factors engineering research and development continue to be essential to HIT development, deployment, and use. [ABSTRACT FROM AUTHOR]

• This study aims to investigate whether the individual characteristics of a physician affect EMR adoption. • A field survey is conducted with a total of 217 physicians and the results indicate that perceived service level is an important antecedent of perceived usefulness. • Computer self-efficacy, perceived risk, and perceived service level are also important antecedents of perceived ease of use. • This study is concluded with implications for academics, hospital managers, governments, and medical information service providers. Most developed countries across the globe are deploying electronic medical record (EMR) as one of the most important initiatives in their healthcare policy. EMR can not only reduce the problems associated with managing paper medical records but also improve the accuracy of medical decisions made by physicians and increase the safety of patients. Considering that physicians are the primary users of EMR, their willingness to use EMR is a critical success factor for EMR implementation in a hospital. This study aims to extend an individual-level information technology adoption model by incorporating three additional variables to investigate whether the individual characteristics of a physician affect EMR adoption. A field survey is conducted with a total of 217 physicians from 15 different academic medical centers and metropolitan hospitals for six weeks. Then, the Structural Equation Modeling (SEM) analysis results indicate that perceived service level is an important antecedent of perceived usefulness. Healthcare technology self-efficacy, perceived risk, and perceived service level are also important antecedents of perceived ease of use. This study is concluded with implications for academics, hospital managers, governments, and medical information service providers. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: Patient falls are the leading cause of unintentional injury and death among older adults. In 2000, falls resulted in over 10,300 elderly deaths, costing the United States approximately $179 million in incidence and medical costs. Furthermore, non-fatal injuries caused by falls cost the United States $19 billion annually. Health information technology (IT) applications, specifically electronic falls reporting systems, can aid quality improvement efforts to prevent patient falls. Yet, long-term residential care facilities (LTRCFs) often do not have the financial resources to implement health IT, and workers in these settings are often not ready to adopt such systems. Additionally, most health IT evaluations are conducted in large acute-care settings, so LTRCF administrators currently lack evidence to support the value of health IT. Methods: In this paper, we detail the development of a novel, easy-to-use system to facilitate electronic patient falls reporting within a LTRCF using off-the-shelf technology that can be inexpensively implemented in a wide variety of settings. We report the results of four complimentary system evaluation measures that take into consideration varied organizational stakeholders’ perspectives: (1) System-level benefits and costs, (2) system usability, via scenario-based use cases, (3) a holistic assessment of users’ physical, cognitive, and marcoergonomic (work system) challenges in using the system, and (4) user technology acceptance. We report the viability of collecting and analyzing data specific to each evaluation measure and detail the relative merits of each measure in judging whether the system is acceptable to each stakeholder. Results and conclusions: The electronic falls reporting system was successfully implemented, with 100% reporting at 3-months post-implementation. The system-level benefits and costs approach showed that the electronic system required no initial investment costs aside from personnel costs and significant benefits accrued from user time savings. The usability analysis revealed several fixable design flaws and demonstrated the importance of scenario-based user training. The technology acceptance model showed that users perceived the reporting system to be useful and easy to use, even more so after implementation. Finally, the holistic human factors evaluation identified challenges encountered when nurses used the system as a part of their daily work, guiding further system redesign. The four-pronged evaluation framework accounted for varied stakeholder perspectives and goals and is a highly scalable framework that can be easily applied to health IT implementations in other LTRCFs. [Copyright &y& Elsevier]

Abstract: Purpose: Implementations of health information technologies are notoriously difficult, which is due to a range of inter-related technical, social and organizational factors that need to be considered. In the light of an apparent lack of empirically based integrated accounts surrounding these issues, this interpretative review aims to provide an overview and extract potentially generalizable findings across settings. Methods: We conducted a systematic search and critique of the empirical literature published between 1997 and 2010. In doing so, we searched a range of medical databases to identify review papers that related to the implementation and adoption of eHealth applications in organizational settings. We qualitatively synthesized this literature extracting data relating to technologies, contexts, stakeholders, and their inter-relationships. Results: From a total body of 121 systematic reviews, we identified 13 systematic reviews encompassing organizational issues surrounding health information technology implementations. By and large, the evidence indicates that there are a range of technical, social and organizational considerations that need to be deliberated when attempting to ensure that technological innovations are useful for both individuals and organizational processes. However, these dimensions are inter-related, requiring a careful balancing act of strategic implementation decisions in order to ensure that unintended consequences resulting from technology introduction do not pose a threat to patients. Conclusions: Organizational issues surrounding technology implementations in healthcare settings are crucially important, but have as yet not received adequate research attention. This may in part be due to the subjective nature of factors, but also due to a lack of coordinated efforts toward more theoretically-informed work. Our findings may be used as the basis for the development of best practice guidelines in this area. [Copyright &y& Elsevier]

Abstract: Purpose: The objective of this paper is to describe how members of HIV patients’ care teams perceived the usefulness and ease of use of newly implemented, innovative health information exchange systems (HIEs) in diverse HIV treatment settings. Five settings with existing electronic medical records (EMRs) received special funding to test enhancements to their systems. Participating clinics and community-based organizations added HIEs permitting bi-directional exchange of information across multiple provider sites serving the same HIV patient population. Methods: We conducted in-depth qualitative interviews and quantitative web-based surveys with case managers, medical providers, and non-clinical staff members to assess the systems’ perceived usefulness and ease of use shortly after the HIEs were implemented. Our approach to data analysis was iterative. We first conducted a thematic analysis of the qualitative data and discovered that there were key differences in perceptions and actual use of HIEs across occupational groups. We used these results to guide our analysis of the quantitative survey data, stratifying by occupational group. Results: We found differences in reports of how useful and how well-used HIEs were, by occupation. Medical providers were more likely to use HIEs if they provided easier access to clinical information than was present in existing EMRs. Case managers working inside medical clinics found HIEs to be less helpful because they already had access to the clinical data. In contrast, case managers working in community settings appreciated the new access to patient information that the HIEs provided. Non-clinical staff uniformly found the HIEs useful for a broad range of tasks including clinic administration, grant writing and generating reports for funders. Conclusion: Our study offers insights into the use and potential benefits of HIE in the context of HIV care across occupational groups. [Copyright &y& Elsevier]

Abstract: Purpose: This paper presents research on the interplay of health information technology (HIT), quality improvement and progression of health status. The purpose of the research was to determine whether electronic exchange of health information impacts quality of care and, by extension, health outcomes of patients with HIV/AIDS. The research was supported as a demonstration project under the Information Technology Networks of Care Initiative sponsored by the U.S. Health Resources and Services Administration, HIV/AIDS Bureau, Special Projects of National Significance (SPNS). The City of Paterson, New Jersey, Department of Health and Human Services administered the project as the grant recipient, secured and managed through the City of Paterson''s Ryan White Part A Program of Bergen and Passaic Counties. Methods: We implemented a web-based health information support system, e2, to facilitate rigorous quality improvement activities associated with care and treatment of HIV/AIDS patients. We used e2 to monitor patient care in the clinic setting. We observed five quality and two health status indicators relating to the care of 263 HIV/AIDS medical patients at three HIV/AIDS medical clinics from 2008 to 2010. The quality indicators conformed to HIV/AIDS Bureau (HAB) Groups 1 and 2 definitions of two or more CD4 T-cell counts performed in the measurement year, AIDS patients prescribed HAART, two or more medical visits in the measurement year, PCP prophylaxis administered to AIDS patients with CD4 T-cell counts <200, and adults screened for syphilis within the measurement year. CD4 T-cell count and viral load suppression indicators were used as health status indicators. Frequency analysis and logistic generalized estimating equations were used to assess correlation. We also assessed user satisfaction with e2 as a quality improvement tool using qualitative methods. Results: Availability of the e2 system was a leading contributing factor in successful quality management activities, leading to improved quality of care and health status of HIV/AIDS patients across all three clinics. Significant improvements were observed in three of the five quality indicators and in both of the two health status indicators. Conclusions: We conclude that health information technology as a tool for rigorous application of quality improvement methods can positively impact quality of care and health outcomes. We found that health outcomes improved over time when quality improvement methods were initiated and facilitated by a responsive electronic information support system. [Copyright &y& Elsevier]