Examining barriers to healthcare providers’ adoption of a hospital-wide electronic patient journey board

Background: The dynamic environment that characterizes patient care in hospitals requires extensive communication between staff. Electronic status board applications are used to improve the flow of communication in hospitals. To date there has been limited work exploring the adoption of these applications in general acute ward settings. Aim: This study aimed to identify barriers to the adoption of an electronic patient journey board (EPJB)1 application in acute wards of a hospital. Method: Data were collected at a large public teaching hospital in Sydney, Australia. The EPJB was implemented across all hospital wards with the aim of improving multidisciplinary communication in wards. Observations (29.5 h) and contextual interviews (n = 33) with hospital staff were conducted in two acute wards of the hospital. Results: Two manual whiteboards were used on wards, in addition to the EPJB, to compensate for information not being available or accessible on the EPJB. Despite the stated purpose of the EPJB, the tool did not appear to support team communication on wards. Barriers to adoption and optimal use of the EPJB included inappropriate location and configuration of the system, limitations in information timeliness, quality and lack of customisation (for different user groups), inconsistent information updates and the absence of a shared understanding of the purpose of the EPJB among the various user groups. Conclusion: Multiple socio-technical barriers influenced uptake and optimal use of the EPJB by healthcare providers. Engaging users early in the design and implementation of electronic status board applications is required to ensure effective use of these complex interventions on general wards

Vital Sensory Kit For Use With Telemedicine In Developing Countries

In many developing countries, a large percentage of the population lacks access to adequate healthcare. This is especially true in India where close to 70% of the population lives in rural areas and has little to no access to hospitals or clinics. People living in rural India often times cannot afford to pay to see a doctor should they need to make the journey to a hospital. Telemedicine, a breakthrough in the past couple decades, has broken down the barrier between the patient and the physician. It has slowly been implemented in India to make doctors more available to patients through the use of video conferences and other forms of communication. A compact and affordable kit has been developed that will be used to take a patient’s blood pressure, heart rate, blood glucose concentration and oxygen saturation. Our most novel contribution is the non-invasive glucose sensor that will use a near-infrared LED and photodiode in the patient’s earlobe. Currently millions of diabetics do this by pricking their finger. By wirelessly sending data results from the vital sign kit, the first essential part of a treatment can be carried out via wireless communication, saving the doctor and patient time and money

Advanced sensors technology survey

This project assesses the state-of-the-art in advanced or 'smart' sensors technology for NASA Life Sciences research applications with an emphasis on those sensors with potential applications on the space station freedom (SSF). The objectives are: (1) to conduct literature reviews on relevant advanced sensor technology; (2) to interview various scientists and engineers in industry, academia, and government who are knowledgeable on this topic; (3) to provide viewpoints and opinions regarding the potential applications of this technology on the SSF; and (4) to provide summary charts of relevant technologies and centers where these technologies are being developed

Health ManagementInformation Systems for Resource Allocation and Purchasing in Developing Countries

World Bank, Health Nutrition and Population, Discussion Paper: The paper begins with the premise that it is not possible to implement an efficient, modern RAP strategy today without the effective use of information technology. The paper then leads the architect through the functionality of the systems components and environment needed to support RAP, pausing to justify them at each step. The paper can be used as a long-term guide through the systems development process as it is not necessary (and likely not possible) to implement all functions at once. The paper’s intended audience is those members of a planning and strategy body, working in conjunction with technical experts, who are charged with designing and implementing a RAP strategy in a developing country

Not Just for Support: Companionship Activities in Healthcare Virtual Support Communities

The phenomenon of social support―aid and assistance exchanged through social relationships and interpersonal transactions―has been studied extensively for decades. In the context of healthcare virtual support communities, researchers have focused on exploring community members’ support behavior and its effects on individuals’ health outcomes. This emphasis, however, has led to the neglect of another type of social interaction that also promotes individual health―companionship activities. We argue that in order to gain a deeper insight into the online support phenomenon, the consideration of companionship activities, in addition to social support exchange, is necessary. To bridge this gap in the literature, this article attempts to contrast community members’ support behavior and companionship activities in two large healthcare virtual support communities―one for patients with breast cancer and the other for patients with prostate cancer. Based on the identification of the two types of social activities from the two cancer support communities, the relationship between individuals’ participation in these activities, and gender differences in their activity engagement are also hypothesized and tested. Our goal is to advance the understanding of online socio-behavioral dynamics of virtual support communities. We also wish to provide insights into the design of such communities and the delivery of patient-focused healthcare interventions

Prescription Drug Monitoring Programs: Evidence-based Practices to Optimize Prescriber Use

As the opioid crisis continues to ravage communities across the United States, policymakers and public health officials are increasingly using new tools such as prescription drug monitoring programs (PDMPs)—state-based electronic databases that track the dispensing of certain controlled substances—to stem the misuse of prescription opioids and reduce overdose deaths.   PDMPs can be used to monitor patient use of these drugs and inform prescribing decisions. However, the number of prescribers actually using these databases in clinical care remains low.A new report from The Pew Charitable Trusts and the Institute for Behavioral Health, Heller School for Social Policy and Management at Brandeis University finds that states can increase prescriber use of PDMPs by adopting one or more of eight evidence-based practices:  Prescriber use mandates, or state laws and regulations that require prescribers to view a patient's PDMP data under certain circumstances. Mandates can rapidly increase PDMP utilization and immediately affect prescriber behavior, which can help prevent "doctor shopping"—when patients seek the same or similar drugs from multiple prescribers and pharmacies in a short period.Delegate access, which allows prescribers to authorize someone on staff, such as a nurse or other member of the health care team, to access the PDMP data on their behalf. The majority of states allow delegate access; evidence suggests such access addresses workflow barriers and increases PDMP use.Unsolicited reports, where prescribers are proactively notified about patients who may be at risk for harm based on their controlled substance prescription history. These alerts can help increase prescriber use in two ways: by motivating them to review patient data and informing unenrolled prescribers about the existence of the PDMP.Improving data timeliness, or increasing the frequency at which data are uploaded into PDMP databases. Many states now require dispensers to upload new data on a daily basis, which increases the timeliness of information and encourages PDMP use.Streamlining enrollment by making it easier for prescribers and delegates to register with their state PDMPs. Enrollment is required before clinicians can check PDMP data, so making this process faster and easier can increase use.Educational and promotional initiatives that help prescribers understand how PDMPs work and encourage their use. Such activities can spur enrolled prescribers and delegates to check PDMP data and inform unenrolled clinicians about the value of these databases. Integrating PDMP data with health information technology, which helps prescribers seamlessly access PDMPs through electronic health records or other IT systems. Pilot projects across the country found that prescribers reported PDMP data were easier to access when the system was integrated into daily workflows. Enhancing PDMP user interfaces, or redesigning how data are presented, to help prescribers more quickly analyze prescribing information and make better-informed decisions.Of the eight practices, mandates are the single most effective way to increase prescriber use. But a mandate alone does not mean that prescribers will use the PDMP effectively in clinical decision-making. Therefore, state officials should explore the other seven strategies and adopt a combination of practices that works best for their program. PDMPs can play a critical role in curbing prescription opioid misuse, but only if states take steps to ensure that the data are easy to access and understand.

Using Intervention Mapping to Develop an Efficacious Multicomponent Systems-Based Intervention to Increase Human Papillomavirus (HPV) Vaccination in a Large Urban Pediatric Clinic Network

Background: The CDC recommends HPV vaccine for all adolescents to prevent cervical, anal, oropharyngeal, vaginal, vulvar, and penile cancers, and genital warts. HPV vaccine rates currently fall short of national vaccination goals. Despite evidence-based strategies with demonstrated efficacy to increase HPV vaccination rates, adoption and implementation of these strategies within clinics is lacking. The Adolescent Vaccination Program (AVP) is a multicomponent systems-based intervention designed to implement five evidence-based strategies within primary care pediatric practices. The AVP has demonstrated efficacy in increasing HPV vaccine initiation and completion among adolescents 10-17 years of age. The purpose of this paper is to describe the application of Intervention Mapping (IM) toward the development, implementation, and formative evaluation of the clinic-based AVP prototype. Methods: Intervention Mapping (IM) guided the development of the Adolescent Vaccination Program (AVP). Deliverables comprised: a logic model of the problem (IM Step 1); matrices of behavior change objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); functional AVP component prototypes (IM Step 4); and plans for implementation (IM Step 5) and evaluation (IM Step 6). Results: The AVP consists of six evidence-based strategies implemented in a successful sequenced roll-out that (1) established immunization champions in each clinic, (2) disseminated provider assessment and feedback reports with data-informed vaccination goals, (3) provided continued medical and nursing education (with ethics credit) on HPV, HPV vaccination, message bundling, and responding to parent hesitancy, (4) electronic health record cues to providers on patient eligibility, and (5) patient reminders for HPV vaccine initiation and completion. Conclusions: IM provided a logical and systematic approach to developing and evaluating a multicomponent systems-based intervention to increase HPV vaccination rates among adolescents in pediatric clinics

Healthcare Management Primer

This primer was written by students enrolled in HMP 721.01, Management of Health Care Organizations, in the Health Management & Policy Program, College of Health and Human Services, University of New Hampshire. This course was taught by Professor Mark Bonica in Fall 2017