The Impact of Certification on Healthcare Information Technology Use

This study examines the effects of certifications such as JCAHO on healthcare information technology (HIT) usage in healthcare organizations and user satisfaction with such usage. Using survey data collected from healthcare administrators in a nation-wide sample of 347 hospitals and long-term care facilities, we provide evidence that certifications do indeed enhance HIT usage and user satisfaction, at least within specialized user groups such as healthcare administrators. We further demonstrate that this increase in HIT usage due to certifications increases with facility size and is more prominent for larger hospitals than for smaller long-term care facilities, though the same cannot be said of user satisfaction. Our study suggests that certifications can be used as a valuable tool for motivating HIT usage, while also drawing attention to an under-examined area of HIT research.

Perceived Level of Benefits and Risk Core Functionalities of an EHR System

The need to adopt an electronic health record (EHR) system in United States (U.S.) hospitals seems to be more and more obvious when evaluating the benefits of improved patient safety, quality of care, and efficiency. The purpose of the study was to identify the status of EHR systems in U.S. hospitals in regard to the core functionalities implemented (as identified by the Institute of Medicine) and to determine if there was a significant relationship between perceived level of benefit and risk with the use of each core functionality, as well as if there was a significant relationship between the status of the EHR system and size of hospital. A national survey of U.S. hospitals was conducted to answer the research questions. The results showed that 37% had some components in all.of the core functionalities of an EHR system, while 27% were using at least some functionalities. Health information and data, administrative processes, and results management were the three core functionalities that a majority of hospitals had as a part of their EHR system. A significant positive correlation between perceived benefits and risks was found in all of the eight core functionalities. There was no significant relationship found between status of EHR system and size of hospitals.

Understanding Physicians' Acceptance of Computerized Physician Order Entry

Computerized physician order entry (CPOE) holds potential of reducing medical errors, improving care quality, and cutting healthcare costs. Yet its success depends on physicians’ acceptance and usage. We test if TAM can be used to explain physician acceptance of CPOE. A survey study was conducted on physicians who have access to CPOE in a large general hospital in China. Data analyses based on 103 responses support all of the relationships predicted by TAM except the one between perceived ease of use and attitude. With additional data analyses, we find that the PEOU-attitude relationship is negatively moderated by physicians’ experience of using CPOE. PEOU does not affect attitude for experienced physicians, whereas when physicians are inexperienced, PEOU has a positive impact on attitude. Our findings suggest that TAM can be applied to explain physicians’ acceptance of CPOE, yet its application should be performed with caution.

Data Mining Medical Information

Trauma audit is intended to develop effective care for injured patients through process and outcome analysis, and dissemination of results. The system records injury details such as the patient’s sex and age, the mechanism of the injury, various measures of the severity of the injury, initial management and subsequent management interventions, and the outcome of the treatment including whether the patient lived or died. Ten years’ worth of trauma audit data from one hospital are modelled as an Artificial Neural Network (ANN) in order to compare the results with a more traditional logistic regression analysis. The output was set to be the probability that a patient will die. The ANN models and the logistic regression model achieve roughly the same predictive accuracy, although the ANNs are more difficult to interpret than the logistic regression model, and neither logistic regression nor the ANNs are particularly good at predicting death. For these reasons, ANNs are not seen as an appropriate tool to analyse trauma audit data. Results do suggest, however, the usefulness of using both traditional and non-traditional analysis techniques together and of including as many factors in the analysis as possible.

Factors Motivating the Acceptance of New Information and Communication Technologies in UK Healthcare

This paper discusses the use of three published models, the technology acceptance model (TAM), Rogers diffusion of innovation theory (IDT), and the Triandis theory of interpersonal behaviour (TIB), and attempts to bring them together in an integrated model to better predict the adoption of new information and communication technologies by a cohort of health professionals within UK primary care in an attempt to aid implementers in bringing technology in at an organizational level.

Designing a M-Health Framework for Conceptualizing Mobile Health Systems

The reference model presented in this chapter encourages the breakdown of m-health systems into the following five key dimensions: communication infrastructure: this is a description of the mobile telecommunication technologies and networks; device type: this relates to the type of device being used such as PDA, sensor, or tablet PC; data display: describes how the data will be displayed to the user and transmitted such as images, e-mail and textual data; application purpose: identification of the objective for the m-health system; application domain: definition of the area that the system will be implemented. Healthcare stakeholders and system implementer can use the reference model presented in this chapter to understand the security implications of the proposed system, identify the technological infrastructure, business requirements and operational needs of the m-health systems being implemented. A reference model to encapsulate the emerging m-health field is needed for cumulative progress in this field. Currently, the m-health field is disjointed and it is often unclear what constitutes an m-health system. In the future, m-health applications will take advantage of technological advances such as device miniaturizations, device convergence, high-speed mobile networks, and improved medical sensors. This will lead to the increased diffusion of clinical m-health systems requiring better understanding of the components, which constitute the m-health system.

Applying Personal Health Informatics to Create Effective Patient-Centered E-Health

E-health use is increasing worldwide, but no current e-health paradigm fulfills the complete range of users’ needs for Web-enabled healthcare services. Moreover, a number of obstacles exist that could make it difficult for e-health to meet users’ expectations, especially in the case where the users are patients. These dilemmas cloud the future of e-health, as promoters of e-commerce, personal health records, and consumer health informatics paradigms vie to create e-health applications while being hampered by the implicit constraints of each perspective. This chapter presents an alternative approach for designing and developing e-health titled personal health informatics (PHI). PHI was developed to overcome the limitations of preceding paradigms while incorporating their best features. The chapter goes on to describe how PHI can be applied to create effective patient-centered e-health for delivery by healthcare organizations to their own patients.

A Case Study of Health Information Systems Adoption

Adaptive structuration theory (AST) is rapidly becoming an important theoretical paradigm for comprehending the impact of advanced information technologies. In this chapter, a modified AST model was designed to illustrate the changing interrelationships among the variables affecting the adoption and application of a new technology into a medical organization setting. Using findings from a case study conducted over a 10-month period, the authors apply the case to the model to illustrate the complex interactions between medical billing technology and organizational processes. As the organization attempted to install and implement the new system, it found that in order to maintain daily operations, it would have to modify and adapt several aspects of the organization, technology and operations. As the system was slowly integrated into operations and the organization’s needs evolved through the adaptation process, the study, in turn, found that different iterations of the model could emphasize different structures. The case illustrated that the capacity to manage health information systems (HIS) often requires the organization to prioritize its needs and focus its energies on a critical structure while temporarily disregarding others until the primary healthcare processes are under control.

Telehealth Organizational Implementation Guideline Issues

The current status of policies, guidelines and standards related to the organizational context of clinical telehealth practice were investigated. The directions these should take to meet the healthcare needs of Canadians also were outlined. An environmental scan approach was employed, consisting of a literature review, stakeholder survey questionnaire, and 12 key informant interviews. The literature review resulted in 260 sources related to organizational leadership issues, of which 176 were abstracted. The stakeholder survey questionnaire response rate was 64% (156/245), with 55% (84/154) completing the organizational context section. All (100%) key informants who were selected for interviews participated. Findings were categorized into four key organizational themes: organizational readiness, quality assurance, accountability, and continuity. Organizations need to review existing policies, standards, and guidelines in order to determine whether telehealth is covered and, if not, revise them or develop new telehealth-specific policies. Telehealth policies and procedures should be integrated with those in existence for face-to-face services.

Evaluation of a Tool to Enhance Searching for Useful Medical Information on the Internet

Evidence-based medicine (EBM) requires appropriate information to be available to clinicians at the point of care. Electronic sources of information may fulfill this need but require a high level of skill to use successfully. This chapter describes the rationale and initial testing of a system to allow collaborative searching and ontology construction for professional groups in the health sector. The approach is based around the use of a browser using a fuzzy ontology based on the National library of medicine (NLM) unified medical language system (UMLS). The results suggest that a tool that can assist users in finding information by recording their preferences and preferred meaning of text words can be usable by healthcare professionals. This approach may provide high-quality information for professionals in the future.