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Objectives: The availability of internet-connected mobile, wearable and ambient consumer technologies, direct-to-consumer e-services and peer-to-peer social media sites far outstrips evidence about the efficiency, effectiveness and efficacy of using them in healthcare applications. The aim of this paper is to describe one approach to build a program of health informatics research, so as to generate rich and robust evidence about health data and information processing in self-quantification and associated healthcare and health outcomes.Methods: The paper summarises relevant health informatics research approaches in the literature and presents an example of developing a program of research in the Health and Biomedical Informatics Centre (HaBIC) at the University of Melbourne. The paper describes this program in terms of research infrastructure, conceptual models, research design, research reporting and knowledge sharing.Results: The paper identifies key outcomes from integrative and multiple-angle approaches to investigating the management of information and data generated by use of this Centre's collection of wearable, mobiles and other devices in health self-monitoring experiments. These research results offer lessons for consumers, developers, clinical practitioners and biomedical and health informatics researchers.Conclusions: Health informatics is increasingly called upon to make sense of emerging self-quantification and other digital health phenomena that are well beyond the conventions of healthcare in which the field of informatics originated and consolidated. To make a substantial contribution to optimise the aims, processes and outcomes of health self-quantification needs further work at scale in multi-centre collaborations for this Centre and for health informatics researchers generally. [ABSTRACT FROM AUTHOR]

Background: Questions like 'How is your health? How are you feeling? How have you been?' now can be answered in a different way due to innovative health self-quantification apps and devices. These apps and devices generate data that enable individuals to be informed and more responsible about their own health.Objectives: The aim of this paper is to review studies on health SQ, firstly, exploring the concepts that are associated with the users' interaction with and around data for managing health; and secondly, the potential benefits and challenges that are associated with the use of such data to maintain or promote health, as well as their impact on the users' certainty or confidence in taking effective actions upon such data.Methods: To answer these questions, we conducted a comprehensive literature review to build our study sample. We searched a number of electronic bibliographic databases including Scopus, Web of Science, Medline, and Google Scholar. Thematic analysis was conducted for each study to find all the themes that are related to our research aims.Results: In the reviewed literature, conceptualisation of health SQ is messy and inconsistent. Personal tracking, personal analytics, personal experimentation, and personal health activation are different concepts within the practice of health SQ; thus, a new definition and structure is proposed to set out boundaries between them. Using the data that are generated by SQS for managing health has many advantages but also poses many challenges.Conclusions: Inconsistency in conceptualisation of health SQ - as well as the challenges that users experience in health self-management - reveal the need for frameworks that can describe the users' health SQ practice in a holistic and consistent manner. Our ongoing work toward developing these frameworks will help researchers in this domain to gain better understanding of this practice, and will enable more systematic investigations which are needed to improve the use of SQS and their data in health self-management. [ABSTRACT FROM AUTHOR]

Effecting early discharge is a widely recommended strategy for improving patient flow in acute hospitals. This paper analyses the impact of inpatient discharge timing on Emergency Department (ED) flow parameters such as access block and length of stay, while comparing this to the effect on hospital occupancy, to arrive at an understanding of a 'whole of hospital' response to discharge timing. The impact of hospital size is also investigated. The analysis reveals that, on days when the discharge peak lags the peak in inpatient admissions, hospitals of all sizes exhibit increased levels of occupancy, inpatient and ED length of stay, and access block. The findings corroborate the efficacy of early discharge initiatives and 'whole of hospital' flow improvement initiatives for addressing overcrowding and efficiency issues in hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Information systems with clinical decision support (CDS) offer great potential to assist the co-ordination of patients with chronic diseases and to improve patient care. Despite this, few have entered routine clinical use. Background: Tuberculosis (TB) is an infection of public health importance. It has complex interactions with many comorbid conditions, requires close supervised care and prolonged treatment for effective cure. These features make it suitable for use with an information management system with CDS features. In close consultation with key stakeholders, a clinical application was developed for the management of TB patients in Victoria. Methods: A formal usability assessment using semi-structured case-scenario based exercises was performed. Subjects were 12 individuals closely involved in the care of TB patients, including Infectious Diseases and Respiratory Physicians, and Public Health Nurses. Two researchers conducted the sessions, independently analysed responses and discrepancies compared to the voice record for validity. Results: Despite varied computer experience, responses were positive regarding user interface and content. Data location was not always intuitive, however this improved with familiarity of the program. Decision support was considered valuable, with useful suggestions for expansion of these features. Automated reporting for correspondence and notification to the Health Department were felt worth the initial investment in data entry. An important workflow-based issue regarding dismissal of alerts and several errors were detected. Conclusion: Usability assessment validated many design elements of the system, provided a unique insight into workflow issues faced by users and hopefully will impact on its ultimate clinical utility. [ABSTRACT FROM AUTHOR]

This paper reports on a national study of the present approaches in Australian tertiary education, to preparing future clinical health professionals to work competently in an increasingly e-health enabled healthcare sector. The argument for increasing clinical health professionals' knowledge about e-health and health informatics has been advanced repeatedly over past decades in Australia and elsewhere. However, peer-reviewed accounts of good practice in implementing and evaluating e-health education in health profession degrees anywhere are scarce. Our study reports on surveying approximately 100 degree coordinators in 40 clinical health professions in 30 universities across Australia. It finds that currently, teaching and assessment of future clinical health professionals does not ensure that Australia will have a clinical workforce that is adequately professionally empowered to work with e-health. This paper provides important baseline data for planning improvements to e-health education for Australia's future clinical health professionals. [ABSTRACT FROM AUTHOR]

Background This paper reports on a small study in which we investigated factors influencing the adoption of Personal Health Records (PHRs), with specific reference to those linked to Electronic Health Records. Long term conditions are a growing concern in healthcare delivery, especially as the need for services outstrips resources. PHRs could be useful in supporting self-care of people with long term conditions, e.g. diabetes. Method We used a Grounded Theory approach to gather initial data to inform future research. This meant that we were guided and informed by data collected.[1] The aim was to find a baseline for PHR research using the Technology Acceptance Model [2], after which emerging topics will be pursued with constant comparison to this first study and subsequent studies. We interviewed ten patients from a Wellington primary care practice who had been using a PHR linked to their doctor's Practice Management System, and observed them using and navigating the software at home. Results: Three groups of factors appeared to influence the participants' use of the PHR. (1) Their perception that convenience, time saving (for them, their GP's practice personnel and their GP), efficiency and effectiveness of care is a result of using the PHR. (2) Computer and health literacy contribute to being able to effectively use the PHR. PHR usage impacts positively on the relationship with their doctor and vice versa, and improves their ability to navigate the health system. (3) It is not clear how PHR-related services are paid for, who pays and under what circumstances. Discussion: These findings are in keeping with those of Santana et al[3] who indicate that patients are interested in viewing and using laboratory results, medicines and diagnosis lists, and ordering repeat prescriptions and corresponding with their clinicians. Literacy does matter, especially in terms of PHRs providing a transparent 'source of truth' and memory aid about medications, laboratory results and diagnoses. The combination of computer and health literacy requires further research. The cost of incorporating PHRs into healthcare services needs to be articulated so that it makes sense in the current capitation funding model. Limitations of this research include the small sample size, bias based on small context and self-selection into the interview cohort. In conclusion, three groups of influencing factors have been elicited from the interviews and observations to indicate potential acceptance and adoption of PHRs in self-care of long term conditions. The next step is to examine the social situatedness of long term conditions and how PHRs support self-care. [ABSTRACT FROM AUTHOR]

Accurate prediction of discharge time and identification of patients at risk of extended length of stay (LOS) can facilitate discharge planning and positively impact both the patient and the hospital in a variety of ways. To date, however, most studies only focus on the prediction of the overall LOS, which is generally estimated at admission time to hospital, emergency department or intensive care unit. This paper explores whether individual laboratory results can improve predictions of time of discharge as the tests become available. This study suggests that there is a statistically significant relationship between individual test results and remaining days in hospital and that there is a trend towards better estimates as more consecutive tests are taken into consideration. Their effect on the estimate of discharge time is generally weak. Further work integrating groups of test results into a more sophisticated dynamical model is required. [ABSTRACT FROM AUTHOR]

Falls are the leading cause of disability, injuries or even death among older adults. Exercise programmes that include a balance component reduce the risk of falling by 40%. However, such interventions are often perceived as boring and drop-out rates are high. The characteristics of videogames may overcome this weakness and increase exercise adherence. The use of modern input devices, such as the Microsoft Kinect, enables quantification of player performance in terms of motor function while engaging with games. This capability has just started to be explored. The work presented in this paper focuses on the development of a Kinect-based system to deliver step training while simultaneously measuring parameters of stepping performance that have shown to predict falls in older people. [ABSTRACT FROM AUTHOR]

One reason that it is so difficult to build electronic systems for collecting and sharing health information is that their design and implementation requires clear goals and a great deal of collaboration among people from diverse social and occupational worlds. This paper uses empirical examples from two Australian health informatics projects to illustrate the importance of boundary objects and boundary spanning activities in facilitating the high degree of collaboration required for the design and implementation of workable systems. [ABSTRACT FROM AUTHOR]

The Intensive Care Unit (ICU) is an information intense environment where Clinical Information Systems (CISs) can greatly impact patient care and the workload of clinicians. With the introduction of an ICU CIS imminent across New South Wales hospitals, we aimed to understand how ICU clinicians perceived a new system would impact on work practices in Australian ICUs, as much of the current evidence is generated from overseas. We conducted interviews with 66 doctors and nurses in 3 ICUs without a CIS. Many had positive perceptions regarding the impact of its introduction, though others were more guarded and unsure. Clinicians believed information access to patient would improve, communication processes could potentially change and there was potential for work processes to be more efficient. It was expected that ward rounds and handover would be less disrupted with all information available at the bedside or at the handover setting. There were mixed responses about whether a CIS would save time and how it would influence patient care, though the majority believed a CIS would improve safety by providing a means for increasing accountability and reducing medication errors. Concerns were raised about the transition from paper to a CIS and the training required. This information provides valuable evidence in the Australian setting regarding clinicians' expectations of a new ICU CIS to assist with future implementations. It also provides baseline data as a foundation for future research once the CIS is implemented. It is clear that robust quantitative studies are required to gain a detailed understanding of how a new CIS will impact clinicians' work processes and that appropriate training is crucial for full benefits to be achieved. [ABSTRACT FROM AUTHOR]

Medication monitoring of ambulatory rheumatology patients on Disease Modifying Anti-Rheumatic Drugs (DMARDS) is time consuming and complex, with possibilities for error. Electronic systems have the potential to improve the process. The aim of this study was to evaluate the impact of an electronic Drug Monitoring System (eDMS) on the time nurses' spent on clinical documentation associated with monitoring. The study was conducted with all nurses (n=4) in the Rheumatology Department of a large metropolitan Australian teaching hospital. The eDMS was designed as a module of the Hospital Clinical Information System (HCIS) to assist clinicians in monitoring rheumatology patients on DMARDS. Timing data were collected using a modified time and motion work measurement technique using software on a handheld computer. Data included the time nurses spent on documentation regarding medication monitoring before and after the implementation of the eDMS. Results showed that following implementation of the eDMS nurses spent significantly less time documenting medication monitoring information (13.6% to 7.2%, P<.0001). The cumbersome paper-based Drug Monitoring Patient List was replaced entirely by the eDMS. Consequently, there was a significant decrease in the time nurses spent using the HCIS (13.01% to 2.8%, p<.0001) for monitoring and the use of loose-leaf paper also decreased (7.6% to 5.0%, p = 0.002). The eDMS made the process of drug monitoring quicker and simpler for nurses and thus permitted them to increase their time spent in direct patient care. [ABSTRACT FROM AUTHOR]