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Much has been written on the benefits of big data for healthcare such as improving patient outcomes, public health surveillance, and healthcare policy decisions. Over the past five years, Big Data, and the data sciences field in general, has been hyped as the "Holy Grail" for the healthcare industry promising a more efficient healthcare system with the promise of improved healthcare outcomes. However, more recently, healthcare researchers are exposing the potential and harmful effects Big Data can have on patient care associating it with increased medical costs, patient mortality, and misguided decision making by clinicians and healthcare policy makers. In this paper, we review the current Big Data trends with a specific focus on the inadvertent negative impacts that Big Data could have on healthcare, in general, and specifically, as it relates to patient and clinical care. Our study results show that although Big Data is built up to be as a the "Holy Grail" for healthcare, small data techniques using traditional statistical methods are, in many cases, more accurate and can lead to more improved healthcare outcomes than Big Data methods. In sum, Big Data for healthcare may cause more problems for the healthcare industry than solutions, and in short, when it comes to the use of data in healthcare, "size isn't everything." [ABSTRACT FROM AUTHOR]

The purpose of this paper is to present a future scenario projecting a fully developed, i.e., mature, personal health record (MPHR) that is instrumental in linking health care services delivery with preventive and wellness activities to provide informed and responsive consumer-driven health care. The legal-regulatory, institutional management, socio-cultural and technological challenges to implementation are discussed to guide future policy development in this area. We conclude that the potential pay-offs for enhancing the individual's health and well-being and protecting and sustaining the public's health overall is worth a considerable investment in policy analysis, technological R&D, partnership building and the expenditure of political capital by influential advocates and decision makers. [ABSTRACT FROM AUTHOR]

In this paper, we have conducted a preliminary study of the applied Clinical Decision Support (CDS) features in adopted Computerized Physician Order Entry (CPOE) systems. The study was conducted in three hospitals in Riyadh, the capital city of Saudi Arabia. The results show that the adoption of CPOE with a Clinical Decision Support System (CDSS) is not yet mature. CPOE systems allow physicians to enter their medication orders electronically, but many of the applied CPOE systems do not contain alerts to advise physicians of potentially dangerous interactions caused by incorrect medications. Hospitals are advised to enhance the role of CDSS with the CPOE to reduce medication errors, improve patients' safety and increase information quality. [ABSTRACT FROM AUTHOR]

Many have addressed the challenge of defining Health Informatics (HI) competencies, and eleven efforts have produced detailed lists of competencies. Although there are commonalities among these lists, several aspects of this work frustrate our using it to define a consensus view of HI competencies. This project has involved the documentation and comparison of the competencies produced by key authors and an effort to suggest competency terminology that derives from and harmonizes these efforts, but does not emphasize any one contribution. It is our hope that this will enable us to use what has gone before with a minimum of reinvention. [ABSTRACT FROM AUTHOR]

Automation bias - the tendency to over-rely on automation - has been studied in a variety of academic fields. Clinical Decision Support Systems aim to benefit the clinical decision making process. Although most research shows overall improved performance with use, there is often a failure to recognize the new errors that CDSS can introduce, and the healthcare field has a gap in this research. This paper outlines some of the most compelling theoretical factors in the literature involved in automation bias, and builds a simple model to be tested empirically. Ultimately, this will uncover the mechanisms by which this bias operates and help CDSS producers and healthcare practitioners optimize the medical decision making process. [ABSTRACT FROM AUTHOR]

At the time of hospital discharge, communication between inpatient and outpatient physicians is poor. Multiple studies demonstrate that discharge summaries, a means of improving information exchange between inpatient and outpatient providers, are frequently not available to the outpatient provider at the time of the post discharge visit. We have constructed a web-based solution for generating discharge summaries, SignOut Discharge Summary System (SDSS) which uses the workflow byproduct of SignOut data to pre-populate summaries, a post-discharge preparation module to ensure quality, a discharge edit module to designate accurate discharge summary assignment, and integration with HIM. SDSS had 1130 unique users in a recent period and captured signout information for 75% of hospitalized patients. The system has generated 78740 D/C summaries for 17 specialties since going live July 2005. Overall SDSS is responsible for 69% of all hospital discharge summaries and SDSS discharge summaries on average are available 1.91 days after discharge. [ABSTRACT FROM AUTHOR]

Psychosocial distress is common in cancer patients. Although common, psychosocial distress is frequently under-diagnosed and poorly managed in the U.S. health system. This paper describes 25 in-depth telephone interviews with health care professionals working within cancer care centers. Interview questions address perception of the psychosocial services offered within their cancer care organizations. Results indicate that access to psychosocial care is frequently dependent upon the subjective judgment of busy clinicians. Information technology could improve the delivery of psychosocial care by easing the administration of psychosocial assessments and increasing clinician contact with research evidence regarding distress management. [ABSTRACT FROM AUTHOR]

Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients. [ABSTRACT FROM AUTHOR]

Background: Replication studies evaluate technologies in usual use settings. Methods: We conducted a clinical trial to determine whether reductions in clinical and economic results observed in a previous study could be replicated in a larger setting. Subjects were randomized to receive intervention (email notifications for sentinel health events sent to their care managers) or control. Main Outcome Measures: The primary outcome was the rate of emergency department visits for low severity conditions. Secondary outcomes included: medical costs and other clinical event rates. Results: We randomized 13,454 individuals (intervention, 6740; control, 6714). Subjects in both groups had similar rates of clinical events and medical costs. Conclusion: The use of email notifications to care managers was associated with no reductions in clinical events or medical costs. [ABSTRACT FROM AUTHOR]

Background: New data management models are emerging in multi-center clinical studies. We evaluated the incremental costs associated with decentralized vs. centralized models. Methods: We developed clinical research network economic models to evaluate three data management models: centralized, decentralized with local software, and decentralized with shared database. Descriptive information from three clinical research studies served as inputs for these models. Main Outcome Measures: The primary outcome was total data management costs. Secondary outcomes included: data management costs for sites, local data centers, and central coordinating centers. Results: Both decentralized models were more costly than the centralized model for each clinical research study: the decentralized with local software model was the most expensive. Decreasing the number of local data centers and case book pages reduced cost differentials between models. Conclusion: Decentralized vs. centralized data management in multi-center clinical research studies is associated with increases in data management costs. [ABSTRACT FROM AUTHOR]

Our greatest hope for the future of eHealth and the enabling of our health system is today's students. However, we face a challenge: few students are aware of careers in Health Informatics and other aspects of eHealth. This paper describes an initiative to engage our future workforce in HI. The National Student Forum for Health Informatics was established, in collaboration between the National Institutes of Health Informatics and COACH, to provide much needed opportunities for students to become involved in HI educational programs, research and student-student interaction. A key activity of NSF is the instantiation of Health Informatics Clubs at Canadian colleges and universities. We describe the rationale for NSF, its goals and objectives, its leadership and organization, and the development of the first HI Club at the University of Waterloo. Initiatives such as NSF are essential if we are to resolve the human resources crisis in HI. [ABSTRACT FROM AUTHOR]

We are reporting on a recent experience with Health Informatics (HI) teaching at undergraduate degree level to an audience of HI and Pharmacy students. The important insight is that effective teaching of clinical informatics must involve highly interactive, applied components in addition to the traditional theoretical material. This is in agreement with general literature underlining the importance of simulations and role playing in teaching and is well supported by our student evaluation results. However, the viability and sustainability of such approaches to teaching hinges on significant course preparation efforts. These efforts consist of time-consuming investigations of informatics technologies, applications and systems followed by the implementation of workable solutions to a wide range of technical problems. In effect, this approach to course development is an involved process that relies on a special form of applied research whose technical complexity could explain the dearth of published reports on similar approaches in HI education. Despite its difficulties, we argue that this approach can be used to set a baseline for clinical informatics training at undergraduate level and that its implications for HI education in Canada are of importance. [ABSTRACT FROM AUTHOR]

Social support has long been positively correlated with cardiac outcomes. However, sources of tension surrounding peer-involvement in the period following acute cardiac events are well documented. Informed by a previous study of patient perspectives of peer-involvement in cardiac rehabilitation, this paper draws from the cardiac and computing literature to provide actionable insights into how technology could be designed to promote appropriate peer-involvement and the challenges that may be faced when designing technologies to support the unsupported. [ABSTRACT FROM AUTHOR]

The use of e-Learning in educational institutes has rapidly increased along with the development of information and communication technology (ICT). In healthcare, more medical educators are using e-Learning to support their curriculum design, delivery and evaluation. However, no systematic work exists on characterizing a collective set of Critical Success Factors (CSFs) for implementing e-Learning in the healthcare education institutions. The aim of this paper is to study the CSFs of implementing healthcare e-Learning [ABSTRACT FROM AUTHOR]

This paper provides an overview of a newly developed course in E-health and Emerging Technology for King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS) Masters of Health Informatics program. The paper provides an overview of the program, description on the course development process, instructional methods, and course evaluation. The paper also describes the faculty's experience in the development of the course. Future evaluation will focus on students' learning experience and content used in the course. [ABSTRACT FROM AUTHOR]

The radiation therapy (RT) department at the British Columbia Cancer Agency - Vancouver Island Centre (VIC) is responsible for delivering radiation treatments to cancer patients from Vancouver Island, which has a population base of approximately 750,000. The purpose of this analysis is to examine a process transformation project undertaken by a VIC clinical champion using a sociotechnical approach and identify factors that influenced the project outcome. Beginning in January 2009, a radiation oncologist at VIC initiated a project to transform the clinical process of generating prescriptions for radiation therapy. The project objective was to replace the paper-based process for radiation therapy (RT) prescriptions with an electronic process to achieve benefits such as increased legibility, accuracy, and accessibility of prescriptions. The electronic prescription (e-Rx) process was designed and developed by health informatics students from the University of Victoria, and the new process was trialed and implemented for approximately half of the new patients seen by the VIC RT department. This pilot implementation was brought to a halt two weeks later, due to concerns raised by the RT department. Using a sociotechnical approach, the authors identify several factors that negatively impacted the project's successful implementation: lack of leadership endorsement and organizational strategy, insufficient formal and informal organizational power of the clinical champion, underestimation of complexity, and inadequate management of the implementation process. Although these factors have been well documented in the literature for large-scale system implementation projects, understanding the way by which they influence smaller-scale process transformation projects in highly specialized clinical settings may help future project managers and coordinators to set such projects up for success. [ABSTRACT FROM AUTHOR]

Ontologies can assist with translating information from an electronic health record to a clinical practice guideline and reformatting it into a compliance report. A 2009 literature search reviews publications on the use of ontologies to support automated reporting of compliance with clinical practice guidelines via electronic health records. Research stage, data-pulling capabilities, ontologies used, and issues raised are some of the comparative data pulled from 13 articles from the literature review results. Suggestions for further research are given. [ABSTRACT FROM AUTHOR]

Document management systems (DMS) have widespread in major hospitals in Japan as a platform to digitize the paper-based records being out of coverage by EPR. This study aimed to examine longitudinal trends of actual use of DMS in a hospital in which EPR had been in operation, which would be conducive to planning the further information management system in the hospital. Degrees of utilization of electronic documents and templates with DMS were analyzed based on data extracted from a university-affiliated hospital with EPR. As a result, it was found that the number of electronic documents as well as scanned documents circulating at the hospital tended to increase. The result indicated that replacement of paper-based documents with electronic documents did not occur. Therefore it was anticipated that the need for DMS would continue to increase in the hospital. The methods used this study to analyze the trend of DMS utilization would be applicable to other hospitals with with a variety of DMS implementation, such as electronic storage by scanning documents or paper preservation that is compatible with EPR. [ABSTRACT FROM AUTHOR]

Governments and providers are investing in health information technologies with little evidence as to their ultimate value. We present a conceptual framework that can be used by hospitals, clinics, and health care systems to evaluate their health information technologies. The framework contains three dimensions that collectively define generic evaluation types. When these types are combined with contextual considerations, they define specific evaluation problems. The first dimension, domain, determines whether the evaluation will address the information intervention or its outcomes. The second dimension, mechanism, identifies the specific components of the new information technology and/or its health care system that will be the subject of the evaluation study. And, the third dimension, timing, determines whether the evaluation occurs before or after the health information technology is implemented. Answers to these questions define a set of evaluation types each with generic sets of evaluation questions, study designs, data collection requirements, and analytic methods. When these types are combined with details of the evaluation context, they define specific evaluation problems. [ABSTRACT FROM AUTHOR]

The emergence of the Personal Health Record (PHR) has made individual health information more readily accessible to a wide range of users including patients, consumers, practitioners, and healthcare providers. However, increased accessibility of PHR threatens the confidentiality, privacy, and security of personalized health information. Therefore, a need for robust and reliable forms of authentication is of prime concern. The concept of biometric authentication is now highly visible to healthcare providers as a technology to prevent unauthorized access to individual health information. Implementing biometric authentication mechanisms to protect PHR facilitates access control and secure exchange of health information. In this paper, a literature review is used to explore the key benefits, technical barriers, challenges, and ethical implications for using biometric authentication in PHR. [ABSTRACT FROM AUTHOR]

Implementation of thin-client computing (TCC) generally requires an elaborate process of determining appropriate specifications of the centralized servers (server sizing). This study aimed to assess the usefulness of the server sizing methods with eight scenarios based on practical usage of an electronic patient record. Actual data obtained from a hospital, where TCC was introduced based on the methods of the study, showed that the stress testing of one of server sizing methods contributed to steady operation of the system, while the scenarios should be improved to reflect more practical workflow in real settings to achieve more precise estimation of the centralized server performance in TCC. [ABSTRACT FROM AUTHOR]

The purpose of this study is to describe early development challenges of an enterprise data warehouse within a Saudi Arabian academic healthcare facility. An action case research method was selected for this paper. The study took place between December 2009 and February 2010. Data collection included interviews, meeting observations, and meeting minutes. Early development challenges centered on the development of clear contracts with vendors; development of a clear project plan; a need to fast-track bureaucracy; and educate clinicians and staff about the project; and lack of data standardization [ABSTRACT FROM AUTHOR]

Around the world a number of countries have made a concerted effort to embed Information and Communications Technology (ICT) within their health systems. It is widely acknowledged that the successful application of ICT to health systems can bring about significant benefits. A number of areas commonly singled out for improvement include: coordination of care; improved medication management; and streamlining the transfer of a patient's care from one healthcare provider to another. There are also perceived cost-benefits including reduced duplication of services and improved service utilization. Countries across the world have chosen many and varied paths to automating their health systems. Health systems are intrinsically very complicated and changing rapidly. Because they represent a high proportion of government expenditure, it is important to understand what is being achieved by each of the broad approaches that are being taken. [ABSTRACT FROM AUTHOR]