Transactions of 2019 International Conference on Health Information Technology Advancement Vol. 4 No. 1

The Fourth International Conference on Health Information Technology Advancement Kalamazoo, Michigan, October 31 - Nov. 1, 2019. Conference Co-Chairs Bernard T. Han and Muhammad Razi, Department of Business Information Systems, Haworth College of Business, Western Michigan University Kalamazoo, MI 49008 Transaction Editor Dr. Huei Lee, Professor, Department of Computer Information Systems, Eastern Michigan University Ypsilanti, MI 48197 Volume 4, No. 1 Hosted by The Center for Health Information Technology Advancement, WM

Wicked complexity in surgical services: analysing perioperative high-risk, work practice organisation and context for future policy implementation

Background: Knowledge of perioperative risk and context are important as year-on-year the global volume of surgery is increasing. Despite decades of policy responses to surgical demand, national registries and local evidence report that a distinct cohort of surgical patients have a higher-than-average risk of complications with added costs to quality of life and service sustainability. The research aim was to examine the impact of context on how in practice the perioperative workforce (comprising clinicians and managers) understand risk, and how this knowledge influences their work practices and use of resources. Three questions were investigated: what has been the impact of health policy on the organisation and practice of perioperative care; how is perioperative work practice organised around low, intermediate and high-risk patients; and what do individuals, teams and organisations require to implement appropriate models of perioperative care for the high-risk patient? Methods: Mixed methods study. The research setting was four university adult general hospitals (113, 360, 440, 547 bed capacity) in a health district in NSW, Australia. Institutional ethics approved a mixed methods study – site observation (187 hours), secondary documents (223 documents: paper and electronic), survey (113 completed) and interviews (143 conducted). Purposive sampling targeted 129 participants in 167 roles, including multidisciplinary clinicians (nurses, doctors and allied health) in senior and junior roles, and managers. Data collection (September 2017 – June 2019) and analysis was conducted using a parallel convergent design through triangulation with descriptive statistics and thematic analysis. Results: National and state health policies that focused on access and efficiency successfully addressed high volume surgical demand for low and intermediate risk patients in predictable, reliable and linear perioperative business process models (BPMs). However, the policies are now three decades old, have resulted in unintended consequences and not addressed the clinical and organisational complexity evident in the three larger hospitals today. The high-risk complex care surgical patient traversed parallel BPMs that were not linear but rather, unpredictable complex adaptive systems. High-risk patients had more invasive surgery and the challenges of chronic multisystem disease and ageing. Complications were more common and cumulative with increased utilisation of hospital resources across multiple fragments of perioperative care; increasing specialty specific expertise were co-opted from multiple clinical disciplines, multiple ‘one-off’ teams were deployed for rescue, resuscitation, and critical care. Complications were associated with months-long hospital stays, discharge to a care level higher than home and readmissions. For high-risk patients the impact of context on the perioperative workforce caring for them could be synthesised as a wicked complexity in perioperative context (WCPC). Wicked complexity is a complexity that was unintended, unwarranted and promulgated by the behaviours of the practice environment. Three research arcs were identified. In the policy arc, at the intersections of the three themes of compression of time and space, fragmentation of care and clinical complexity, there was a wicked complexity in competing priorities and demands (WCCPD) arising from the pressure on clinicians and managers to deal with the ‘here and now’ and not delay care processes downstream. In the risk and practice arc, at the intersections of the three themes of multiple incomplete understandings of high-risk, work practice organisation and an unclear patient outcome measure, there was a wicked complexity in gaps in fully comprehending high-risk (WCGFCHR). In the interprofessional arc, at the intersections of the three themes of professional immersion, multiple formations of perioperative teams and using technology, there was a wicked complexity in gaps in perspective (WCGP). Service sustainability in the perioperative system evolved to encompass WCPC. WCPC was the outcome and rendered solutions clinicians, managers and the organisation derived by continually adjusting elements of care to address current challenges. Wicked complexity in perioperative context is represented by the equation: WCPC = WCCPD +WCGFCHR + WCGP Discussion: Continually adjusting elements of perioperative care to address current challenges is supported by frontline clinicians and the initiatives of local and international medical colleges and societies However, the consequences of continuing this strategy alone without acknowledging and addressing WCPC, include: the potential practical inability of the majority of clinicians and clinician managers to be involved with new initiatives as they continue to struggle with competing priorities and demands in day-to day practice, the organisational gaps in fully comprehending high-risk and the cultural gaps in perspective. The research shows that what is critically needed is a commonly agreed and complete definition of perioperative high-risk that considers the impact of context and culture. The impact of context on the perioperative workforce and their patients can be clearly analysed and articulated. Addressing WCPC systematically enables the charting of an evolving course to equip clinicians and managers to: deal with the impact of context, face economic challenges to service sustainability and address the needs of the high-risk complex care perioperative patient. It is necessary and time to revisit a policy strategy that was successful short-term, a workforce generation ago when surgical services were first re-engineered. Namely, an investment in leadership for the future, capable of generating the solutions to optimising care for the high-risk surgical patient, both clinically and contextually. This may only be achieved through interprofessional education and collaboration at all levels of policy enactment, across all professions. The health services research perspective that enabled defining WCPC could work to simultaneously address clinical complexity, context and culture

Reaching across organisational, sectoral and geographical boundaries: exploring the learning potential of an EU cross-border project

Research This paper outlines some of the key findings from an evaluation of the project and demonstrates that EC funded projects such as this, which seek to promote cross border collaboration and understanding (i.e. across organisational, sectoral and geographical boundaries) offer considerable learning potential – not least about variances in health politics across different communities. However, for this learning to be realised a comprehensive system of knowledge management needs to be an integral part of project planning alongside a system for sustaining embryonic professional networks. The concept of managing relationships was also a key part of the projects success. Executing a project funded by the EU demands the development of complex organisational skills to negotiate all the administrative challenges en route to successful completion and this project in particular relied for its success on the development of social relationships of trust and mutual respect across national, professional and social boundaries. Context A three–year European Commission funded project designed to exchange a wide range of staff (professional semiprofessional and voluntary staff in health and social care) project led by the University of Greenwich (UK) and the Université Catholique de Lille, France was completed this year (February 2008). The project was complex because it involved working in different national contexts, was multi-disciplinary, and demanded the negotiation of multiple boundaries. Theories A mixed method evaluation including written reports gathered immediately after each exchange visit and a post hoc series of individual interviews and focus groups was conducted in order to gain qualitative information (from the participants perspective) on their experiences and to identify any learning gained. Results Analysis of the data provided evidence of learning on a number of levels; personally, inter and intra professionally and organisationally as well as across sectors and also from a project management perspective. The learning crystallised around the extent of the differences noted by the participants between the UK and the French health and social care systems despite geographical proximity, common membership of the EU and many shared challenges in health and social care. The extent of these differences, noted at every level from policy to practice proved a rich source for reflection on organisational philosophies, ways of working, distribution of resources, professional roles and autonomy and professional registration and mobility - in short on health politics at ‘macro’ and ‘micro’ levels

Low value care in surgery

Background Value has been defined as the ratio of quality outcomes to cost. Perfect value would represent infinitely beneficial outcomes associated with minimal costs. Of interest to the present study are interventions where outcomes are minimal, and costs may be high as they may provide an opportunity for disinvestment, improving the overall value of care whilst providing efficiency gains. Methods A Scoping Narrative Review was performed in order to understand incumbent approaches towards dealing with low value care. International lessons from different processes were identified and encompassed into a conceptual logic orientated framework for de-adoption. To identify low value care in surgery a Systematic review of peer reviewed high-level literature was performed to identify candidate interventions for de-adoption. Subsequently a granular assessment of the behaviour of passive de-adoption was performed through a retrospective longitudinal observational study based upon administrative hospital data. Results A comprehensive conceptual model that takes an integrated approach to de-adoption was assembled from lessons learnt when dealing with low value care previously. It identified three stages in the de-adoption cycle which are necessary for success: identification, implementation and re-evaluation. Each process should be performed at multiple planes: national (macro), local (meso) and provider / patient (micro) levels in order to have a holistic effect. The identification of low value interventions may be from exploring peer reviewed literature, as demonstrated from the systematic review or exploring geographical variation of care. Said review identified 71 low value procedures, of which 5 interventions which carried the highest economic burden were postulated to cost the health system £135 million per annum. Subsequent granular review identified that passive levers have not resulted in de-adoption of a surgical low value interventions – e.g. delayed cholecystectomy. This is due to the presence of exnovator providers whom are concurrently de-adopting innovative interventions as other providers are adopting them. Conclusions Low value care represents a significant burden in the current health service. This thesis has evaluated its incidence and economic burden in general surgery. Service transformation is necessary and may be achieved through the holistic integrated approach recommended here. Policy makers have already sought this novel information and encompassed it into national policy, with the objective of achieving higher value care through effective de-adoption.Open Acces

Application of modern statistical methods in worldwide health insurance

With the increasing availability of internal and external data in the (health) insurance industry, the demand for new data insights from analytical methods is growing. This dissertation presents four examples of the application of advanced regression-based prediction techniques for claims and network management in health insurance: patient segmentation for and economic evaluation of disease management programs, fraud and abuse detection and medical quality assessment. Based on different health insurance datasets, it is shown that tailored models and newly developed algorithms, like Bayesian latent variable models, can optimize the business steering of health insurance companies. By incorporating and structuring medical and insurance knowledge these tailored regression approaches can at least compete with machine learning and artificial intelligence methods while being more transparent and interpretable for the business users. In all four examples, methodology and outcomes of the applied approaches are discussed extensively from an academic perspective. Various comparisons to analytical and market best practice methods allow to also judge the added value of the applied approaches from an economic perspective.Mit der wachsenden Verfügbarkeit von internen und externen Daten in der (Kranken-) Versicherungsindustrie steigt die Nachfrage nach neuen Erkenntnissen gewonnen aus analytischen Verfahren. In dieser Dissertation werden vier Anwendungsbeispiele für komplexe regressionsbasierte Vorhersagetechniken im Schaden- und Netzwerkmanagement von Krankenversicherungen präsentiert: Patientensegmentierung für und ökonomische Auswertung von Gesundheitsprogrammen, Betrugs- und Missbrauchserkennung und Messung medizinischer Behandlungsqualität. Basierend auf verschiedenen Krankenversicherungsdatensätzen wird gezeigt, dass maßgeschneiderte Modelle und neu entwickelte Algorithmen, wie bayesianische latente Variablenmodelle, die Geschäftsteuerung von Krankenversicherern optimieren können. Durch das Einbringen und Strukturieren von medizinischem und versicherungstechnischem Wissen können diese maßgeschneiderten Regressionsansätze mit Methoden aus dem maschinellen Lernen und der künstlichen Intelligenz zumindest mithalten. Gleichzeitig bieten diese Ansätze dem Businessanwender ein höheres Maß an Transparenz und Interpretierbarkeit. In allen vier Beispielen werden Methodik und Ergebnisse der angewandten Verfahren ausführlich aus einer akademischen Perspektive diskutiert. Verschiedene Vergleiche mit analytischen und marktüblichen Best-Practice-Methoden erlauben es, den Mehrwert der angewendeten Ansätze auch aus einer ökonomischen Perspektive zu bewerten

The Second International Conference on Health Information Technology Advancement

TABLE OF CONTENTS I. Message from the Conference Co-Chairs B. Han and S. Falan …………………………....….……………. 5 II. Message from the Transactions Editor H. Lee …...………..………….......………….……….………….... 7 III. Referred Papers A. Emerging Health Information Technology and Applications The Role of Mobile Technology in Enhancing the Use of Personal Health Records Mohamed Abouzahra and Joseph Tan………………….……………. 9 Mobile Health Information Technology and Patient Care: Methods, Themes, and Research Gaps Bahae Samhan, Majid Dadgar, and K. D. Joshi…………..…. 18 A Balanced Perspective to Perioperative Process Management Jim Ryan, Barbara Doster, Sandra Daily, and Carmen Lewis…..….…………… 30 The Impact of Big Data on the Healthcare Information Systems Kuo Lane Chen and Huei Lee………….…………… 43 B. Health Care Communication, Literacy, and Patient Care Quality Digital Illness Narratives: A New Form of Health Communication Jofen Han and Jo Wiley…..….……..…. 47 Relationships, Caring, and Near Misses: Michael’s Story Sharie Falan and Bernard Han……………….…..…. 53 What is Your Informatics Skills Level? -- The Reliability of an Informatics Competency Measurement Tool Xiaomeng Sun and Sharie Falan.….….….….….….…. 61 C. Health Information Standardization and Interoperability Standardization Needs for Effective Interoperability Marilyn Skrocki…………………….…….………….… 76 Data Interoperability and Information Security in Healthcare Reid Berryman, Nathan Yost, Nicholas Dunn, and Christopher Edwards.…. 84 Michigan Health Information Network (MiHIN) Shared Services vs. the HIE Shared Services in Other States Devon O’Toole, Sean O’Toole, and Logan Steely…..……….…… 94 D. Health information Security and Regulation A Threat Table Based Approach to Telemedicine Security John C. Pendergrass, Karen Heart, C. Ranganathan, and V.N. Venkatakrishnan …. 104 Managing Government Regulatory Requirements for Security and Privacy Using Existing Standard Models Gregory Schymik and Dan Shoemaker…….…….….….… 112 Challenges of Mobile Healthcare Application Security Alan Rea………………………….……………. 118 E. Healthcare Management and Administration Analytical Methods for Planning and Scheduling Daily Work in Inpatient Care Settings: Opportunities for Research and Practice Laila Cure….….……………..….….….….… 121 Predictive Modeling in Post-reform Marketplace Wu-Chyuan Gau, Andrew France, Maria E. Moutinho, Carl D. Smith, and Morgan C. Wang…………...…. 131 A Study on Generic Prescription Substitution Policy as a Cost Containment Approach for Michigan’s Medicaid System Khandaker Nayeemul Islam…….…...……...………………….… 140 F. Health Information Technology Quality Assessment and Medical Service Delivery Theoretical, Methodological and Practical Challenges in Designing Formative Evaluations of Personal eHealth Tools Michael S. Dohan and Joseph Tan……………….……. 150 The Principles of Good Health Care in the U.S. in the 2010s Andrew Targowski…………………….……. 161 Health Information Technology in American Medicine: A Historical Perspective Kenneth A. Fisher………………….……. 171 G. Health Information Technology and Medical Practice Monitoring and Assisting Maternity-Infant Care in Rural Areas (MAMICare) Juan C. Lavariega, Gustavo Córdova, Lorena G Gómez, Alfonso Avila….… 175 An Empirical Study of Home Healthcare Robots Adoption Using the UTUAT Model Ahmad Alaiad, Lina Zhou, and Gunes Koru.…………………….….………. 185 HDQM2: Healthcare Data Quality Maturity Model Javier Mauricio Pinto-Valverde, Miguel Ángel Pérez-Guardado, Lorena Gomez-Martinez, Martha Corrales-Estrada, and Juan Carlos Lavariega-Jarquín.… 199 IV. A List of Reviewers …………………………..…….………………………208 V. WMU – IT Forum 2014 Call for Papers …..…….…………………20