Health information technology foresight for Iran: A Delphi study of experts’ views to inform future policymaking

2019 ◽  
Vol 50 (1-2) ◽  
pp. 76-87
Author(s):  
Morteza Hemmat ◽  
Haleh Ayatollahi ◽  
Mohammadreza Maleki ◽  
Fatemeh Saghafi
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Delphi Study ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Faculty Members ◽  
Future Health ◽  
Third Phase ◽  
Patient Provider Communication

Background: Policymakers require a systematic approach when planning for information technology needs in healthcare. Objective: The aim of this study was to obtain experts’ predictions of future health information technology (HIT) needs until 2025 for Iran in relation to the relative importance of key technologies, expected timeframe of realisation, areas that may be impacted upon and obstacles to achieving these goals. Method: This article presents results from the third phase (a Delphi study) of a larger mixed-method study. Policymakers from the Iranian Ministry of Health and faculty members from different medical universities across the country who were expert in the field of HIT were invited to participate ( n = 61). Results: Participants (39) completed the first-round questionnaire and 24 completed the second. The development of personal health records ( n = 32, 82.0%), the development of clinical decision-making systems ( n = 30, 76.9%) and the use of business intelligence for collecting and analysing clinical and financial data ( n = 32, 82.0%) were predicted to occur after 2025. The healthcare areas predicted to experience the greatest impact from most HITs were facilitating patient–provider communication and improving healthcare quality. Key barriers to achieving HITs were related to weaknesses in planning and limited financial resources for most technologies. Conclusion: By identifying the areas of impact and the barriers to achieving the HIT goals, more accurate planning is possible and resources can be allocated according to priorities.

scholarly journals Informatics and interaction: Applying human factors principles to optimize the design of clinical decision support for sepsis

2019 ◽  
Vol 26 (1) ◽  
pp. 642-651
Author(s):  
Laura Schubel ◽  
Danielle L Mosby ◽  
Joseph Blumenthal ◽  
Muge Capan ◽  
Ryan Arnold ◽  
...  
Keyword(s):  
Information Technology ◽  
Decision Support ◽  
Human Factors ◽  
Organ Failure ◽  
Health Information Technology ◽  
Health Information ◽  
Clinical Decision Support ◽  
Clinical Care ◽  
Clinical Decision ◽  
Wide Range

In caring for patients with sepsis, the current structure of electronic health record systems allows clinical providers access to raw patient data without imputation of its significance. There are a wide range of sepsis alerts in clinical care that act as clinical decision support tools to assist in early recognition of sepsis; however, there are serious shortcomings in existing health information technology for alerting providers in a meaningful way. Little work has been done to evaluate and assess existing alerts using implementation and process outcomes associated with health information technology displays, specifically evaluating clinician preference and performance. We developed graphical model displays of two popular sepsis scoring systems, quick Sepsis Related Organ Failure Assessment and Predisposition, Infection, Response, Organ Failure, using human factors principles grounded in user-centered and interaction design. Models will be evaluated in a larger research effort to optimize alert design to improve the collective awareness of high-risk populations and develop a relevant point-of-care clinical decision support system for sepsis.

scholarly journals Effects of health information technology on patient outcomes: a systematic review

2015 ◽  
Vol 23 (5) ◽  
pp. 1016-1036 ◽  
Author(s):  
Samantha K Brenner ◽  
Rainu Kaushal ◽  
Zachary Grinspan ◽  
Christine Joyce ◽  
Inho Kim ◽  
...  
Keyword(s):  
Information Technology ◽  
Patient Safety ◽  
Health Information Technology ◽  
Health Information ◽  
Clinical Decision ◽  
Cochrane Library ◽  
Health It ◽  
Term Care ◽  
Safety Outcomes

Abstract Objective To systematically review studies assessing the effects of health information technology (health IT) on patient safety outcomes. Materials and Methods The authors employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement methods. MEDLINE, Cumulative Index to Nursing Allied Health (CINAHL), EMBASE, and Cochrane Library databases, from 2001 to June 2012, were searched. Descriptive and comparative studies were included that involved use of health IT in a clinical setting and measured effects on patient safety outcomes. Results Data on setting, subjects, information technology implemented, and type of patient safety outcomes were all abstracted. The quality of the studies was evaluated by 2 independent reviewers (scored from 0 to 10). A total of 69 studies met inclusion criteria. Quality scores ranged from 1 to 9. There were 25 (36%) studies that found benefit of health IT on direct patient safety outcomes for the primary outcome measured, 43 (62%) studies that either had non-significant or mixed findings, and 1 (1%) study for which health IT had a detrimental effect. Neither the quality of the studies nor the rate of randomized control trials performed changed over time. Most studies that demonstrated a positive benefit of health IT on direct patient safety outcomes were inpatient, single-center, and either cohort or observational trials studying clinical decision support or computerized provider order entry. Discussion and Conclusion Many areas of health IT application remain understudied and the majority of studies have non-significant or mixed findings. Our study suggests that larger, higher quality studies need to be conducted, particularly in the long-term care and ambulatory care settings.

From Bench to Bed: Bridging from Informatics Theory to Practice

2014 ◽  
Vol 53 (06) ◽  
pp. 511-515 ◽  
Author(s):  
R. Haux ◽  
C. U. Lehmann
Keyword(s):  
Information Technology ◽  
Decision Support ◽  
Health Information Technology ◽  
Health Information ◽  
Hospital Admissions ◽  
Clinical Decision ◽  
Clinical Informatics ◽  
Documentation Quality ◽  
Theory To Practice ◽  
Complex Patient

SummaryBackground: In 2009, the journal Applied Clinical Informatics (ACI) commenced publication. Focused on applications in clinical informatics, ACI was intended to be a companion journal to Methods of Information in Medicine (MIM). Both journals are official journals of IMIA, the International Medical Informatics Association.Objectives: To explore, after five years, which congruencies and interdependencies exist in publications of these journals and to determine if gaps exist. To achieve this goal, major topics discussed in ACI and in MIM had to be analysed. Finally, we wanted to explore, whether the intention of publishing these companion journals to provide an information bridge from informatics theory to informatics practice and from practice to theory could be supported by this model. In this manuscript we will report on congruencies and interdependencies from practise to theory and on major topis in ACI. Further results will be reported in a second paper.Methods: Retrospective, prolective observational study on recent publications of ACI and MIM. All publications of the years 2012 and 2013 from these journals were indexed and analysed.Results: Hundred and ninety-six publications have been analysed (87 ACI, 109 MIM). In ACI publications addressed care coordination, shared decision support, and provider communication in its importance for complex patient care and safety and quality. Other major themes included improving clinical documentation quality and efficiency, effectiveness of clinical decision support and alerts, implementation of health information technology systems including discussion of failures and succeses. An emerging topic in the years analyzed was a focus on health information technology to predict and prevent hospital admissions and managing population health including the application of mobile health technology. Congruencies between journals could be found in themes, but with different focus in its contents. Interdependencies from practise to theory found in these publications, were only limited.Conclusions: Bridging from informatics theory to practise and vice versa remains a major component of successful research and practise as well as a major challenge.

scholarly journals Everything but the Kitchen Sink: A Mixed Methods Approach to Health IT Usability Testing

2019 ◽  
Vol 63 (1) ◽  
pp. 718-722
Author(s):  
Laura Schubel ◽  
Robin Littlejohn ◽  
Ronald Romero Barrientos ◽  
Ryan Arnold ◽  
Muge Capan ◽  
...  
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Usability Testing ◽  
Clinical Decision ◽  
User Needs ◽  
Health It ◽  
Mixed Methods Approach ◽  
Healthcare Environment ◽  
Think Aloud Protocols

Usability testing has become a necessary step to successfully implement health information technology, but despite the expanded variety of usability methods, systems still are not guaranteed to meet user needs in a hectic and dynamic healthcare environment. The present work discusses some of the metrics employed with the intent of usability testing clinical decision support alerts for the early identification of sepsis patients. By utilizing methods such as eye tracking, think aloud protocols, human computer interaction, and more, health information technology can be adequately developed to ensure effective, efficacious, and optimal integration.

scholarly journals Developing and Applying a Formative Evaluation Framework for Health Information Technology Implementations: Qualitative Investigation

10.2196/15068 ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. e15068 ◽  
Author(s):  
Kathrin Cresswell ◽  
Robin Williams ◽  
Aziz Sheikh
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Structural Changes ◽  
Formative Evaluation ◽  
Clinical Decision ◽  
Evaluation Framework ◽  
Electronic Prescribing ◽  
Data Set ◽  
Formative Evaluations

Background There is currently a lack of comprehensive, intuitive, and usable formative evaluation frameworks for health information technology (HIT) implementations. We therefore sought to develop and apply such a framework. This study describes the Technology, People, Organizations, and Macroenvironmental factors (TPOM) framework we developed. Objective The aim was to develop and apply a formative evaluation framework for HIT implementations, highlighting interrelationships between identified dimensions and offering guidance for implementers. Methods We drew on an initial prototype framework developed as part of a literature review exploring factors for the effective implementation of HIT. In addition, we used qualitative data from three national formative evaluations of different HIT interventions (electronic health record, electronic prescribing, and clinical decision support functionality). The combined data set comprised 19 case studies of primarily hospital settings, and included 703 semistructured interviews, 663 hours of observations, and 864 documents gathered from a range of care settings across National Health Service (NHS) England and NHS Scotland. Data analysis took place over a period of 10 years and was guided by a framework informed by the existing evidence base. Results TPOM dimensions are intimately related and each include a number of subthemes that evaluators need to consider. Although technological functionalities are crucial in getting an initiative off the ground, system design needs to be cognizant of the accompanying social and organizational transformations required to ensure that technologies deliver the desired value for a variety of stakeholders. Wider structural changes, characterized by shifting policy landscapes and markets, influence technologies and the ways they are used by organizations and staff. Conclusions The TPOM framework supports formative evaluations of HIT implementation and digitally enabled transformation efforts. There is now a need for prospective application of the TPOM framework to determine its value.

scholarly journals Compatibility of Family History Cancer Guidelines With Meaningful Use Standards

2017 ◽  
pp. 1-9
Author(s):  
Ayesha Aziz ◽  
Lance Pflieger ◽  
Nathaniel O’Connell ◽  
Joshua Schiffman ◽  
Brandon M. Welch
Keyword(s):  
Information Technology ◽  
Decision Support ◽  
Health Information Technology ◽  
Health Information ◽  
Clinical Decision Support ◽  
Meaningful Use ◽  
Clinical Decision ◽  
Cancer Type ◽  
Cancer Guidelines ◽  
Technology Systems

Purpose To evaluate the potential of implementing established family cancer guidelines as clinical decision support within meaningful use (MU)–compliant health information technology systems. Methods We conducted a systematic analysis of cancer guidelines involving family health history (FHx) published before 2015. By comparing existing cancer guideline statements to current MU FHx standard requirements, we determined whether the cancer guideline statements could be implemented as clinical decision support. For guidelines that could not implemented, we determined the primary reasons for incompatibility. Results A total of 531 statements from 55 guidelines published by 11 different organizations were reviewed and analyzed. Overall, 18% to 66% of guideline statements could or could not be implemented in MU-compliant health information technology systems, depending on which MU standard was used. Health Level Seven (HL7) models performed better than SNOMED models. Implementability of guideline statements varied by cancer type and guideline organizations. The greatest deficiencies in implementability of statements were largely a result of the fact that MU standards required only first-degree relatives and that FHx terms used in guidelines statements were ambiguous. Conclusion FHx cancer guidelines and MU-based systems vary widely and are mostly incompatible. We identified sources of incompatibility and made recommendations that could improve the implementability of FHx cancer guidelines. Our findings and recommendations can enhance the use of established FHx cancer risk guidelines in routine clinical workflows.

scholarly journals Developing and Applying a Formative Evaluation Framework for Health Information Technology Implementations: Qualitative Investigation (Preprint)

2019 ◽  
Author(s):  
Kathrin Cresswell ◽  
Robin Williams ◽  
Aziz Sheikh
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Structural Changes ◽  
Formative Evaluation ◽  
Clinical Decision ◽  
Evaluation Framework ◽  
Electronic Prescribing ◽  
Data Set ◽  
Formative Evaluations

BACKGROUND There is currently a lack of comprehensive, intuitive, and usable formative evaluation frameworks for health information technology (HIT) implementations. We therefore sought to develop and apply such a framework. This study describes the Technology, People, Organizations, and Macroenvironmental factors (TPOM) framework we developed. OBJECTIVE The aim was to develop and apply a formative evaluation framework for HIT implementations, highlighting interrelationships between identified dimensions and offering guidance for implementers. METHODS We drew on an initial prototype framework developed as part of a literature review exploring factors for the effective implementation of HIT. In addition, we used qualitative data from three national formative evaluations of different HIT interventions (electronic health record, electronic prescribing, and clinical decision support functionality). The combined data set comprised 19 case studies of primarily hospital settings, and included 703 semistructured interviews, 663 hours of observations, and 864 documents gathered from a range of care settings across National Health Service (NHS) England and NHS Scotland. Data analysis took place over a period of 10 years and was guided by a framework informed by the existing evidence base. RESULTS TPOM dimensions are intimately related and each include a number of subthemes that evaluators need to consider. Although technological functionalities are crucial in getting an initiative off the ground, system design needs to be cognizant of the accompanying social and organizational transformations required to ensure that technologies deliver the desired value for a variety of stakeholders. Wider structural changes, characterized by shifting policy landscapes and markets, influence technologies and the ways they are used by organizations and staff. CONCLUSIONS The TPOM framework supports formative evaluations of HIT implementation and digitally enabled transformation efforts. There is now a need for prospective application of the TPOM framework to determine its value.

scholarly journals Identifying Health Information Technology Needs of Oncologists to Facilitate the Adoption of Genomic Medicine: Recommendations From the 2016 American Society of Clinical Oncology Omics and Precision Oncology Workshop

2017 ◽  
Vol 35 (27) ◽  
pp. 3153-3159 ◽  
Author(s):  
Kevin S. Hughes ◽  
Edward P. Ambinder ◽  
Gregory P. Hess ◽  
Peter Paul Yu ◽  
Elmer V. Bernstam ◽  
...  
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Genomic Medicine ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Knowledge Bases ◽  
Test Case ◽  
Precision Oncology ◽  
Support Tool

At the ASCO Data Standards and Interoperability Summit held in May 2016, it was unanimously decided that four areas of current oncology clinical practice have serious, unmet health information technology needs. The following areas of need were identified: 1) omics and precision oncology, 2) advancing interoperability, 3) patient engagement, and 4) value-based oncology. To begin to address these issues, ASCO convened two complementary workshops: the Omics and Precision Oncology Workshop in October 2016 and the Advancing Interoperability Workshop in December 2016. A common goal was to address the complexity, enormity, and rapidly changing nature of genomic information, which existing electronic health records are ill equipped to manage. The subject matter experts invited to the Omics and Precision Oncology Workgroup were tasked with the responsibility of determining a specific, limited need that could be addressed by a software application (app) in the short-term future, using currently available genomic knowledge bases. Hence, the scope of this workshop was to determine the basic functionality of one app that could serve as a test case for app development. The goal of the second workshop, described separately, was to identify the specifications for such an app. This approach was chosen both to facilitate the development of a useful app and to help ASCO and oncologists better understand the mechanics, difficulties, and gaps in genomic clinical decision support tool development. In this article, we discuss the key challenges and recommendations identified by the workshop participants. Our hope is to narrow the gap between the practicing oncologist and ongoing national efforts to provide precision oncology and value-based care to cancer patients.

Utilizing health information technology to improve the recognition and management of life-threatening adrenal crisis in the pediatric emergency department: medical alert identification in the 21st century

2019 ◽  
Vol 32 (5) ◽  
pp. 513-518
Author(s):  
Kelsee L. Halpin ◽  
Emily L. Paprocki ◽  
Ryan J. McDonough
Keyword(s):  
Emergency Department ◽  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Clinical Decision ◽  
Pediatric Emergency ◽  
Adrenal Crisis ◽  
Life Threatening ◽  
The Impact ◽  
To Receive

AbstractBackgroundMany barriers exist to the appropriate recognition and management of life-threatening adrenal crisis in the emergency department (ED). Clinical decision support (CDS) is a health information technology (IT) component that provides useful information to providers as healthcare is being delivered. We hypothesized that CDS incorporated into the electronic health record (EHR) could improve the recognition and management of adrenal crisis within the pediatric ED.MethodsWe retrospectively analyzed the impact of electronic CDS on the management of patients with known adrenal insufficiency (AI) presenting to two pediatric ED locations over a 19-month period with symptoms suggestive of adrenal crisis. Outcome variables assessed included the frequency of hydrocortisone (HC) administration, appropriateness of HC dosing, and timing to HC order placement and administration.ResultsA total of 145 encounters were reviewed. When the electronic CDS was in place at the time of the ED visit, patients were nearly 3 times as likely to receive HC (p = 0.002). Among those patients who received HC, the presence of the CDS increased the likelihood of an appropriate 50-mg/m2dose of HC being given from 20 to 53% (p = 0.02). However, the CDS did not significantly reduce the time from ED arrival to HC order placement (p = 0.36) or administration (p = 0.59).ConclusionsThe use of innovative health IT strategies, such as the electronic CDS, can improve the recognition and management of adrenal crisis among patients with AI presenting to the pediatric ED.

Sign in / Sign up

Export Citation Format

Share Document