Operationalizing the Science

Healthcare IT (HIT) has failed to live up to its promise in the United States. HIT solutions and decisions need to be evidence based and standardized. Interventional informatics is ideally positioned to provide evidence based and standardized solutions in the enterprise (aka, the medical center) which includes all or some combination of hospital(s), hospital based-practices, enterprise owned offsite medical practices, faculty practice and a medical school. For purposes of this chapter, interventional informatics is defined as applied medical or clinical informatics with an emphasis on an active interventional role in the enterprise. A department of interventional informatics, which integrates the science of informatics into daily operations, should become a standard part of any 21st century medical center in the United States. The objectives of this chapter are to: review and summarize the promise and challenge of IT in healthcare; define healthcare IT; review the legacy of IT in healthcare; compare and contrast IT in healthcare with that of other industries; become familiar with evidence based IT: Medical informatics; differentiate medical informatics from IT in healthcare; distinguish medical, clinical, and interventional informatics; justify the need for operational departments of interventional informatics.

Health Information Technology Economic Evaluation

This chapter describes a framework for conducting economic analyses of health information technologies (HIT). It explains the basic principles of healthcare economic analyses and the relationships between the costs and effectiveness of a health intervention, and then uses these principles to explain the types of data that need to be gathered in order to conduct a health information technology economic evaluation study. A current health information technology study is then used to illustrate the incorporation of the framework’s economic analysis methods into an ongoing research project. Economic research in the field of health information technology is not yet well developed. This chapter is meant to educate researchers about the need for HIT economic analyses as well as provide a structured framework to assist them in conducting these analyses.

Legal Issues in Health Information and Electronic Health Records

This chapter discusses key legal issues raised by the contemporary trend to managing and sharing patient information via electronic health records (EHR). Concepts of privacy, confidentiality, consent, and security are defined and considered in the context of EHR initiatives in Canada, the United Kingdom, and Australia. This chapter explores whether patients have the right to withhold consent to the collection and sharing of their personal information via EHRs. It discusses opt-in and opt-out models for participation in EHRs and concludes that presumed consent for EHR participation will ensure more rapid and complete implementation, but at the cost of some personal choice for patients. The reduction in patient control over personal information ought to be augmented with strong security protections to minimize risks of unauthorized access to EHRs and fulfill legal and ethical obligations to safeguard patient information.

Knowledge Translation in Nursing Through Decision Support at the Point of Care

With advances in electronic health record systems and mobile computing technologies it is possible to re-conceptualize how health professionals access information and design appropriate decision-support systems to support quality patient care. This chapter uses the context of nursing-sensitive patient outcomes data collection to explore how technology can be used to increase nurses’ and other health professionals’ access to patient outcomes information in real time to continually improve patient care. The chapter draws upon literature related to: (1) case-based reasoning, (2) feedback, (3) and evidence-based nursing practice to provide the theoretical foundation for an electronic knowledge translation intervention that was developed and tested for usability. Directions for future research include the need to understand how nurses experience uncertainty in their practice, how this influences information seeking behavior, and how information resources can be designed to support real-time clinical decision making.

Technology Enabled Knowledge Translation

Because of the rapid growth of health evidence and knowledge generated through research, and growing complexity of the health system, clinical care gaps increasingly widen where best practices based on latest evidence are not routinely integrated into everyday health service delivery. Therefore, there is a strong need to inculcate knowledge translation strategies into our health system so as to promote seamless incorporation of new knowledge into routine service delivery and education to promote positive change in individuals and the health system towards eliminating the clinical care gaps. E-health, the use of information and communication technologies (ICT) in health which encompasses telehealth, health informatics, and e-learning, can play a prominently supportive role. This chapter examines the opportunities and challenges of technology enabled knowledge translation (TEKT) using ICT to accelerate knowledge translation in today’s health system with two case studies for illustration. Future TEKT research and evaluation directions are also articulated.

A Comparison of How Canada, England, and Denmark are Managing their Electronic Health Record Journeys

Healthcare is one of the world’s most information-intensive industries. Every day, volumes of data are produced which, properly used, can improve clinical practice and outcomes, guide planning and resource allocation, and enhance accountability. Electronic health information is fundamental to better healthcare. There will be no significant increase in healthcare quality and efficiency without high quality, user-friendly health information compiled and delivered electronically. The growing use of information and communication technology (ICT) in the healthcare sector has introduced numerous opportunities and benefits to patients, providers and governments alike. Patients are being provided with tools to help them manage and monitor their healthcare, providers are able to seamlessly access up-to-date patient information, and governments are showing transparency to the public by reporting health data and information on their websites. There is mounting evidence that national, regional, and organizational e-health strategies are being developed and implemented worldwide. This chapter provides an overview of three different national e-health strategies, and identifies the lessons learned from the e-health strategies of Canada, England and Denmark.

Evaluation Methods to Monitor Success and Failure Factors in Health Information System's Development

This chapter discusses the extent to which factors known to influence the success and failure of health information systems may be evaluated. More specifically, this is concerned with evaluation of such factors— for screening, diagnostic or preventive purposes—by means of existing evaluation methods designed for users. The author identifies that it is feasible to identify evaluation methods for most success factors and failure criteria. However, there is a need for situational methods engineering as the methods are not dedicated to answering the precise information needs of the project management. Therefore, demands are being placed on the evaluators’ methodical and methodological skills, when evaluating health information systems. The author concludes the chapter by pointing at research needs and opportunities.

Accountability, Beneficence, and Self-Determination

Existing literature often addresses the ethical problems posed by health informatics. Instead of this problem-based approach, this chapter explores the ethical benefits of health information systems in an attempt to answer the question “can health information systems make organizations more accountable, beneficent, and more responsive to a patient’s right to self determination?” It does so by unpacking the accountability for reasonableness framework in ethical decision making and the concepts of beneficence and self-determination. The framework and the concepts are discussed in light of four commonly used health information systems, namely: Web-based publicly accessible inventories of services; Web-based patient education; telemedicine; and the electronic medical record. The objective of this chapter is to discuss the ethical principles that health information systems actually help to achieve, with a view to enabling researchers, clinicians, and managers make the case for the development and maintenance of these systems in a client-centered fashion.

Regional Patient Safety Initiatives

Data-sharing systems—where healthcare providers jointly implement a common reporting system to promote voluntary reporting, information sharing, and learning—are emerging as an important regional, state-level, and national strategy for improving patient safety. The objective of this chapter is to review the evidence regarding the effectiveness of these data-sharing systems and to report on the results of an analysis of data from the Pittsburgh Regional Healthcare Initiative (PRHI). PRHI consists of 42 hospitals, purchasers, and insurers in southwestern Pennsylvania that implemented Medmarx, an online medication error reporting systems. Analysis of data from the PRHI hospitals indicated that the number of errors and corrective actions reported initially varied widely with organizational characteristics such as hospital size, JCAHO accreditation score and teaching status. But the subsequent trends in reporting errors and reporting actions were different. Whereas the number of reported errors increased significantly, and at similar rates, across the participating hospitals, the number of corrective actions reported per error remained mostly unchanged over the 12-month period. A computer simulation model was developed to explore organizational changes designed to improve patient safety. Four interventions were simulated involving the implementation of computerized physician order entry, decision support systems and a clinical pharmacist on hospital rounds. The results of this study carry implications for the design and assessment of data-sharing systems. Improvements in patient safety require more than voluntary reporting and clinical initiatives. Organizational changes are essential in order to significantly reduce medical errors and adverse events.

Enhancing ‘Fit' of Health Information Systems Design Through Practice Support

The design and implementation of healthcare information systems (HIS) is problematic as many HIS projects do not achieve the desired outcomes. There exist a number of theories to enhance our ability to successfully develop HIS. Examples of such theories include ‘fit’ and the sociotechnical approach. However, there are few empirical studies that illustrate how to understand and operationalize such theories at the empirical level needed for HIS design. This chapter introduces a practice support framework that bridges the gap between the theoretical and empirical aspects of HIS design by identifying specific process and information practice supports that need to be considered to actively produce fit of an HIS within a healthcare setting. The chapter also provides an empirical case study of how practice support was used to develop a computer based tool in the domain area of palliative care severe pain management.