Investigating Evaluation Frameworks for Electronic Health Record: A Literature Review

BACKGROUND: There are various electronic health records (EHRs) evaluation frameworks with multiple dimensions and numerous sets of evaluation measures, while the coverage rate of evaluation measures in a common framework varies in different studies. AIM: This study provides a literature review of the current EHR evaluation frameworks and a model for measuring the coverage rate of evaluation measures in EHR frameworks. METHODS: The current study was a comprehensive literature review and a critical appraisal study. The study was conducted in three phases. In Phase 1, a literature review of EHR evaluation frameworks was conducted. In Phase 2, a three-level hierarchical structure was developed, which includes three aspects, 12 dimensions, and 110 evaluation measures. Subsequently, evaluation measures in the identified studies were categorized based on the hierarchical structure. In Phase 3, relative frequency (RF) of evaluation measures in different dimensions and aspects for each of the identified studies were determined and categorized as follows: Appropriate, moderate, and low coverage. RESULTS: Out of a total of 8276 retrieved articles, 62 studies were considered relevant. The RF range in the second and third level of the hierarchical structure was between 8.6%–91.94% and 0.2%–61%, respectively. “Ease of use” and “system quality” were the most frequent evaluation measure and dimension. Our results indicate that identified studies cover at least one and at most nine evaluation dimensions and current evaluation frameworks focus more on the technology aspect. Almost in all identified studies, evaluation measures related to the technology aspect were covered. However, evaluation measures related to human and organization aspects were covered in 68% and 84% of the identified studies, respectively. CONCLUSION: In this study, we systematically reviewed all literature presenting any type of EHR evaluation framework and analyzed and discussed their aspects and features. We believe that the findings of this study can help researchers to review and adopt the EHR evaluation frameworks for their own particular field of usage

COMMUNITY ENGAGED APPROACH TO CANCER CONTROL POLICY IN ABIA STATE - NIGERIA: A MIXED-METHODS ACTION RESEARCH PROJECT

Background Cancers are becoming increasingly common in Nigeria and other developing countries. The most common cancers in the country are those affecting the breast, cervix, and prostate. Beyond the National Cancer Control Plan, most States in Nigeria do not have State cancer control policies which is unlike the situation in Canada and other developed countries. Using the multiple perspective analysis framework, this research sought to explore the perspectives of patients diagnosed with cancer, healthcare providers and health policymakers regarding cancer policy in Abia State. Methods A concurrent mixed methods action research design was used. Sampling included individuals aged ≥18 years who were diagnosed with breast or cervical cancer, provided cancer treatment or made health policy in the State. This study was conducted in collaboration with the Abia Cancer Control Group (ACCG), a community-based coalition of non-governmental organizations, clinicians, and government parastatals. Survey data were collected at the same time as the interviews which occurred following ethical approvals from the University of Saskatchewan’s Behavioural Research Ethics Board and Abia State’s Ministry of Health Human Research Ethics Committee. Results/Findings Survey participants were 29 patients who had been diagnosed with cancer, 50 health care providers and 33 policymakers (n=112), with an average age of 45 (±11) years. Challenges identified by ≥60% of participants were: lack of local data regarding cancers (95.2%, 79/83); lack of treatment pathways (92.8%, 77/83); absence of support groups for patients (88.0%, 73/83); low public awareness (75.9%, 63/83); and limited availability of treatment options (62.6%, 52/83). Some themes that evolved from the qualitative data were: low cancer awareness; delays in cancer treatment; and, financial burden on patients. The top three priority areas for a new cancer control policy were: cancer prevention (83%, 93/112); State cancer legislation (80%, 86/112); and multi-agency partnerships (79%, 88/112). Most participants (80%, 90/112) recommended that health insurance should fund ≥16% of cancer control activities, although policymakers were more likely to make quarterly insurance contributions than patients (7 out of 10 vs. 5 out of 10). Data from participants that agreed to be interviewed (n=24) were grouped into the following themes: Experiences (e.g. challenges regarding cancer prevention, awareness of early detection, delays in cancer service, and cost of services) and Expectations (e.g. priority rating for cancer control, funding structure, and framework for a future cancer control policy). ACCG provided contextual evidence of the usefulness of these findings by organizing community-driven cancer control projects locally linked to advocacy, training of clinicians, patient navigation and support, as well as developing a centralized cancer reporting system. Conclusion Cancer control was an important issue for all populations. Inadequate early detection services with a background of >3-month diagnostic delay characterized cancer control in Abia State. Future cancer control policy should emphasize: cancer prevention; the creation of local clinical pathways; and, a blended model for financing cancer control activities. Collaboration with community groups such as ACCG will be critical to the successful development and implementation of a cancer control policy in Abia State

Advanced Use of Electronic Health Records in Patient-Centered Medical Homes

Electronic Health Records (EHRs) offer the promise of improved health outcomes through care coordination, in particular for costly and difficult to manage chronic illness. Adoption levels of EHRs in primary care have increased significantly since the recent Meaningful Use policy initiative began incentivizing EHRs in 2011; however, the full benefits of EHRs will only be realized once widespread use of advanced EHR functions is achieved. Patient-Centered Medical Homes (PCMHs) are considered the pinnacle of primary care and are expected to rely heavily on EHRs to coordinate care across settings. The goals of this dissertation are to describe and discuss overall EHR adoption and use in PCMH practices, including the practices’ progress towards meeting advanced criteria for the Meaningful Use policy, and to identify and explain the specific PCMH practice characteristics and contextual factors associated with advanced EHR use. This dissertation utilizes innovative data on PCMHs to create and evaluate an advanced EHR use index and explore the iterative differences distinguishing advanced EHR use from no advanced use in PCMHs. The EHR index is the dependent variable defining the levels of advanced EHR use by the PCMH. Four models of advanced EHR use are created and variations in the models are explored to validate the EHR index and identify the PCMH practice characteristics associated with advanced EHR use at higher levels of the EHR index. This dissertation indicates higher EHR adoption and use levels for PCMHs compared to other office-based and primary care practices in the current literature. Practice size, type, and location (rural versus non-rural) of the PCMH demonstrate unique associations with advanced EHR use. Contrary to prior studies, this dissertation indicates that larger PCMHs as well as federally-funded centers are less likely to be advanced EHR users and that practice affiliation (being part of a network) has no association with advanced use; also, smaller and non-rural PCMHs practices that are physician or hospital/system-owned are more likely to be using advanced EHR functions, which is also contrary to previous research. These findings have significant implications for future policies, practice, and research. As advanced EHR use becomes more widespread, the findings from this study provide future researchers with robust baseline data on PCMHs. The measures of EHR adoption and use levels in this study, as well as the various models tested, provide frameworks for future studies to evaluate and track advanced EHR use in primary care