Automation and Adaptation: Information Technology, Work Practices, and Labor Demand at Three Firms

The use of information and communication technology to automate routine tasks involves two types of innovation: technological and organizational. Together, improvements in technological capabilities and complementary changes made by firms in the way they organize work and implement work practices constitute the conditions under which machines substitute for or complement human workers. Building on the prevailing model of routine-biased technical change and recent insights into organizational complementarities, I conduct three qualitative case studies in health care and real estate to assess the relationship between technology and firm-level labor demand. Unique combinations of technological innovation, organizational complementarity, and decision-making at each firm produce differential impacts for labor demand, with even similar technologies exhibiting quite different patterns of substitution for workers of all skill types. In addition, studying firm-level complementarities illuminates how and why the scope of the routine task may be growing, with particularly important implications for relatively higher skill workers

Information technologies that facilitate care coordination: provider and patient perspectives

Health information technology is a core infrastructure for the chronic care model, integrated care, and other organized care delivery models. From the provider perspective, health information exchange (HIE) helps aggregate and share information about a patient or population from several sources. HIE technologies include direct messages, transfer of care, and event notification services. From the patient perspective, personal health records, secure messaging, text messages, and other mHealth applications may coordinate patients and providers. Patient-reported outcomes and social media technologies enable patients to share health information with many stakeholders, including providers, caregivers, and other patients. An information architecture that integrates personal health record and mHealth applications, with HIEs that combine the electronic health records of multiple healthcare systems will create a rich, dynamic ecosystem for patient collaboration

An electronic health record system implementation in a resource limited country—lessons learned

Electronic health records have revolutionized the medical world by improving medical care, refining provider documentation, standardizing care, and minimizing sentinel events. Successful implementation of electronic health records remains a daunting task and requires careful strategic planning and buy-in from key stakeholders. Much has been published in resource-rich settings and high-income countries about implementations of electronic health records. However, little is known about the experience in resource-limited settings where challenges remain unique and distinct from other parts of the world. Our intention is to share lessons learned during implementation of a web-based electronic health record at a tertiary care center in Kenya

Improving Patient Safety and Hospital Service Quality Through Electronic Medical Record: A Systematic Review

ABSTRACT To understand the Electronic medical records (EMR) role in improving patient safety and hospital’s service quality. Articles that included and assessed for the eligibility in this review was an article that show an effect of patient’ safety, and product quality in hospital in correlation on using EMR. The most important function of EMR implementation is to improve patient safety in hospital, in addition to reducing cost. EMR reduce excess cost of Hospital Acquired Condition (HAC) by 16%, reduce death due to HAC by 34%. Doctor and nurse’s belief that the quality of patient data is better when EMR are easier to use and suit with their dialy routine. EMR can improve patient safety, but its use require some skills in technology so it won’t turn to harm patients’ safety. The implementation EMR requires the ability of skilled human resources in using technologies, computer and programs

Association of Electronic Health Records with Methicillin-Resistant Staphylococcus aureus Infection in a National Sample

This study examined the relationship between advanced electronic health record (EHR) use in hospitals and rates of Methicillin-resistant Staphylococcus aureus (MRSA) infection in an inpatient setting. National Inpatient Sample (NIS) and Health Information Management Systems Society (HIMSS) Annual Survey are combined in the retrospective, cross-sectional analysis. A twenty percent simple random sample of the combined 2009 NIS and HIMSS datasets included a total of 1,032,905 patient cases of MRSA in 550 hospitals. Results of the propensity-adjusted logistic regression model revealed a statistically significant association between advanced EHR and MRSA, with patient cases from an advanced EHR being less likely to report a MRSA diagnosis code

Characterization and Representation of Patient Use of Virtual Health Technology in Primary Care

Purpose. Advances in virtual care technology have made healthcare more convenient and accessible. The goal of this study was to elucidate current patient portal behaviors by examining the pattern of time and service type use of patients, via data provided by access logs within electronic health records, to increase communication and care coordination through online healthcare portals. Methods. We conducted a retrospective study of patients in an academic healthcare center over a 5-year period using access log records in electronic health records (EHR). Dimensionality reduction analysis was applied to group portal functionalities into more interpretable and meaningful feature domains, followed by negative binomial regression analysis to evaluate how patient and practice characteristics affected the use of each feature domain. Results. Patient portal usage was categorized into four feature domains: messaging, health information management, billing/insurance, and resource/education. Individuals having more chronic conditions, lab tests or prescriptions generally had greater patient portal usage. However, patients who were male, elderly, in minority groups, or living in rural areas persistently had lower portal usage. Individuals on public insurance were also less likely than those on commercial insurance to use patient portals, though Medicare patients showed greater portal usage on health information management features and uninsured patients had greater usage on viewing resource/education features. Having Internet access only affected the use of messaging features, but not other feature. Conclusions. Efforts in enrolling patients in online portals does not guarantee patients using the portals to manage their health. While promoting the use of virtual health tools as part of patient-center care delivery model, primary care clinicians need to be aware of technological, socioeconomic, and cultural challenges faced by their patients

Can artificial intelligence improve the management of pneumonia

The use of artificial intelligence (AI) to support clinical medical decisions is a rather promising concept. There are two important factors that have driven these advances: the availability of data from electronic health records (EHR) and progress made in computational performance. These two concepts are interrelated with respect to complex mathematical functions such as machine learning (ML) or neural networks (NN). Indeed, some published articles have already demonstrated the potential of these approaches in medicine. When considering the diagnosis and management of pneumonia, the use of AI and chest X-ray (CXR) images primarily have been indicative of early diagnosis, prompt antimicrobial therapy, and ultimately, better prognosis. Coupled with this is the growing research involving empirical therapy and mortality prediction, too. Maximizing the power of NN, the majority of studies have reported high accuracy rates in their predictions. As AI can handle large amounts of data and execute mathematical functions such as machine learning and neural networks, AI can be revolutionary in supporting the clinical decision-making processes. In this review, we describe and discuss the most relevant studies of AI in pneumonia

Send Us the Bitcoin or Patients Will Die: Addressing the Risks of Ransomware Attacks on Hospitals

Part I of this Article describes how the healthcare industry has arrived in this place of vulnerability, including (1) the history of the movement toward EHRs through HIPAA, (2) HIPAA’s meaningful use regulations and the background of current ransomware attacks, and (3) the distinctions between these attacks and other security breaches that have plagued large insurers and health systems within the last five years. Next, Part II will examine current industry culture when it comes to cybersecurity and review current legal and business approaches to address this growing threat. Then, Part III will argue that, while the current laws—including HIPAA and HITECH—are a good start, they do not go far enough to curb the current ransomware attacks and thus, should be amended. It will further argue that such amendments cannot be the only solution. Rather, the healthcare industry has to spur its own movement toward better and tighter security over its healthcare technology. Lastly, this Article will conclude with some suggestions and recommendations for how industry and government regulators can work together to assure that hospitals and health systems are not faced with the dilemma of having to choose between patient safety and the payment of a bitcoin ransom

Features and frequency of use of electronic health records in primary care across 20 countries:a cross-sectional study

Objectives: Variation exists in the capabilities of electronic healthcare records (EHRs) systems and the frequency of their use by primary care physicians (PCPs) from different settings. We aimed to examine the factors associated with everyday EHRs use by PCPs, characterise the EHRs features available to PCPs, and to identify the impact of practice settings on feature availability. Study design: Cross-sectional study. Methods: PCPs from 20 countries completed cross-sectional online survey between June and September 2020. Responses which reported frequency of EHRs use were retained. Associations between everyday EHRs use and PCP and practice factors (country, urbanicity, and digital maturity) were explored using multivariable logistic regression analyses. The effect of practice factors on the variation in availability of ten EHRs features was estimated using Cramer's V. Results: Responses from 1520 out of 1605 PCPs surveyed (94·7%) were retained. Everyday EHRs use was reported by 91·2% of PCPs. Everyday EHRs use was associated with PCPs working &gt;28 h per week, having more years of experience using EHRs, country of employment, and higher digital maturity. EHRs features concerning entering, and retrieving data were available to most PCPs. Few PCPs reported having access to tools for ‘interactive patient education’ (37·3%) or ‘home monitoring and self-testing of chronic conditions’ (34·3%). Country of practice was associated with availability of all EHRs features (Cramer's V range: 0·2–0·6), particularly with availability of tools enabling patient EHRs access (Cramer's V: 0·6, P &lt; 0.0001). Greater feature availability of EHRs features was observed with greater digital maturity. Conclusions: EHRs features intended for patient use were uncommon across countries and levels of digital maturity. Systems-level research is necessary to identify the country-specific barriers impeding the implementation of EHRs features in primary care, particularly of EHRs features enabling patient interaction with EHRs, to develop strategies to improve systems-wide EHRs use.</p