Applying and Extending the FITT Framework to Identify the Challenges and Opportunities of Successful eHealth Services for Patient Self-Management : Qualitative Interview Study

Background: The number of public eHealth services that support patient self-management is rapidly increasing. However, the implementation of these eHealth services for self-management has encountered challenges. Objective: The purpose of this paper was to analyze the challenges and opportunities of implementing eHealth services for self-management by focusing on the fit between the technical solution and clinical use. Methods: We performed in-depth interviews with 10 clinical project coordinators and managers who were responsible for developing and implementing various eHealth services for self-management interventions in five university hospitals in Finland The results were analyzed using content analysis and open coding. The Fit between Individuals, Task, and Technology (FITT) framework was used to interpret the findings. Results: The implementation of self-management services involved many challenges related to technical problems, health professional acceptance, patient motivation, and health organization and management. The implementers identified practices to manage the identified challenges, including improving the design of the technology, supporting health professionals in the adoption of the eHealth services, changing the work processes and tasks, involving patients, and collectively planning the implementation inside an organization. The findings could be mostly attributed to the dimensions of the FITT framework. Conclusions: The FITT framework helped to analyze the challenges related to the implementation, and most of them were related to poor fit. The importance of patients as stakeholders in eHealth services for patient self-management needs to be highlighted. Thus, we propose that patients should be added as a different type of individual dimension to the FITT framework. In addition, the framework could be extended to include organization and management in a new context dimension.Peer reviewe

How to Avoid Common Pitfalls of Health IT Implementation

The stories in this guide were based on case studies about a specific intensive care IT system that integrates information from bedside monitors into a single intuitive display to provide better real-time information for clinicians

Applying and Extending the FITT Framework to Identify the Challenges and Opportunities of Successful eHealth Services for Patient Self-Management: Qualitative Interview Study

Background: The number of public eHealth services that support patient self-management is rapidly increasing. However, the implementation of these eHealth services for self-management has encountered challenges.Objective: The purpose of this paper was to analyze the challenges and opportunities of implementing eHealth services for self-management by focusing on the fit between the technical solution and clinical use.Methods: We performed in-depth interviews with 10 clinical project coordinators and managers who were responsible for developing and implementing various eHealth services for self-management interventions in five university hospitals in Finland The results were analyzed using content analysis and open coding. The Fit between Individuals, Task, and Technology (FITT) framework was used to interpret the findings.Results: The implementation of self-management services involved many challenges related to technical problems, health professional acceptance, patient motivation, and health organization and management. The implementers identified practices to manage the identified challenges, including improving the design of the technology, supporting health professionals in the adoption of the eHealth services, changing the work processes and tasks, involving patients, and collectively planning the implementation inside an organization. The findings could be mostly attributed to the dimensions of the FITT framework.Conclusions: The FITT framework helped to analyze the challenges related to the implementation, and most of them were related to poor fit. The importance of patients as stakeholders in eHealth services for patient self-management needs to be highlighted. Thus, we propose that patients should be added as a different type of individual dimension to the FITT framework. In addition, the framework could be extended to include organization and management in a new context dimension.</div

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

Evaluation of Mobile Telephone Text Message Reminders for People with Antipsychotic Medication

Nonadherence to treatment is a worldwide problem among people with severe mental disorders. Patient treatment adherence may be supported with simple reminding methods e.g. text message reminders. However, there is limited evidence of its benefits. Intervention evaluation is essential in mHealth research. Therefore, this evaluative study was conducted. This study aimed to evaluate text message reminder use in encouraging patients’treatment adherence among people with antipsychotic medication. The data were collected between September 2011 and December 2013. First, a systematic literature review revealed that text message reminders were widely used in healthcare. However, its impacts were conflicting. Second, a sub-sample (n = 562) analysis showed that patients preferred humorous text message reminders and preferred to receive them in the morning, at the beginning of the week. Age, gender and marital status seemed to have different effects on the preferred amount and timing of the selected reminders. Third, a cross-sectional survey revealed that people with antipsychotic medication (n = 408) expressed overall satisfaction towards the reminder system. Finally, the evaluative design showed that patient recruitment for a randomized controlled trial concerning people with antipsychotic medication was challenging due to low rates of eligible participants. Follow-up drop-out rates varied depending on the data collection method. Participants’ demographic characteristics were associated with the risk of dropping out from the trial. This study suggests that text messages are a potential reminder system in healthcare services among people with antipsychotic medication. More research is needed to gain a comprehensive picture of the impacts and effectiveness of text message reminders.Tekstiviestimuistutusten arviointi psykoosilääkitystä käyttävillä potilailla Huono hoitoon sitoutuminen on maailmanlaajuinen ongelma ihmisillä, joilla on vakava mielenterveyshäiriö. Hoitoon sitoutumista voidaan kuitenkin tukea yksinkertaisilla muistutusmenetelmillä, kuten tekstiviesteillä. Tekstiviestimuistutusten hyödyistä antipsykoosilääkitystä käyttävän potilaan hoitoon sitoutumisen tukemisessa tiedetään kuitenkin vain vähän. Interventioiden arviointi on olennainen osa mobiiliterveyden tutkimusta. Tästä syystä tämä arviointitutkimus toteutettiin. Tutkimuksen tarkoituksena oli arvioida tekstiviestimuistutusten käyttöä antipsykoosilääkitystä käyttävän potilaan hoitoon sitoutumisen tukemisessa. Aineisto kerättiin syyskuun 2011 ja joulukuun 2013 välillä. Ensiksi, systemaattinen kirjallisuuskatsaus osoitti, että tekstiviestimuistutuksia käytetään laajasti terveydenhuollossa. Tulokset tekstiviestimuistutusten hyödyistä olivat kuitenkin ristiriitaiset. Toiseksi, osajoukon (n = 562) analyysi osoitti, että osallistujat pitivät humoristisista tekstiviestimuistutuksista ja halusivat vastaanottaa ne aamuisin alkuviikosta. Osallistujien iällä, sukupuolella ja siviilisäädyllä näytti olevan yhteys potilaiden valitsemien tekstiviestien määrään ja siihen, mihin aikaan osallistujat halusivat vastaanottaa viestejä. Kolmanneksi, kyselytutkimus toi esille, että antipsykoosilääkitystä käyttävät potilaat (n = 408) olivat yleisesti tyytyväisiä saamaansa tekstiviestipalveluun. Lopuksi, arviointitutkimuksen mukaan antipsykoosilääkityksen omaavien potilaiden rekrytoiminen randomoituun kontrolloituun tutkimukseen oli haasteellista johtuen muun muassa sisäänottokriteerit täyttävien potilaiden vähäisestä määrästä. Tutkimuksen keskeyttäneiden osallistujien määrä vaihteli riippuen seuranta-aineiston keruuseen käytetystä menetelmästä. Osallistujien taustatekijät olivat yhteydessä riskiin keskeyttää tutkimus. Tutkimuksen mukaan tekstiviestit ovat mahdollinen muistutusjärjestelmä terveydenhuollossa antipsykoosilääkitystä käyttävien potilaiden keskuudessa. Lisää tutkimusta tarvitaan luomaan yhtenäinen käsitys tekstiviestimuistutusten hyödyistä ja vaikuttavuudesta.Siirretty Doriast

Digital technologies to support mental health among young people

The aim of this study was to describe how digital technologies can support young people in mental health services. An explorative mixed methods study was conducted in three phases. First, a systematic literature review was carried out between 2011 and 2013, followed by a meta-analysis of three studies to examine the effectiveness of a virtual reality intervention used in specialized psychiatric care. Second, the use of an electronic diary (e-diary) was explored among young people (n=89) who were clients of adolescent psychiatric outpatient clinics between 2008 and 2010 due to depressive symptoms. Third, the use of web-based community services aimed at young people (n=2,193) in 2018 was explored. In the second and third stages, quantitative data were analyzed with descriptive analysis and qualitative data with inductive thematic analysis. No quality evidence for or against virtual reality usage among people with serious mental health problems was found in the systematic review and meta- analysis. The young people’s long-term use of the e-diary was low, and nearly half of the participants did not use it at all. Those who did use the e-diary had previous experiences in mental health services and had more severe symptoms of depression than those who did not use it. Most of the young people who used digital technologies during treatment at the adolescent psychiatric outpatient clinics and in the community were females. According to the study results, digital technologies were most often used in the evenings and during the school year. Young people openly discussed their mental health and their personal issues such as relationships, identity, social life, health and illnesses, and self-perception. Digital technologies have the potential to help young people monitor their behavior, symptoms, and experiences and get support when they need it. When developing and implementing mental health support based on digital technologies, it is important to consider the different mental health and gender-specific needs of young people, as well as their readiness to use digital technologies to support their own mental health and well-being.Digitaaliset teknologiat nuorten mielenterveyden tukena Tämän tutkimuksen tavoitteena oli kuvata, miten digitaalisia teknologioita voidaan käyttää nuorten mielenterveyden tukena mielenterveyspalveluissa. Tutkimus toteutettiin kolmessa vaiheessa. Ensimmäisessä vaiheessa systemaattinen kirjallisuuskatsaus tehtiin vuosina 2011–2013, jonka jälkeen tehtiin meta-analyysi kolmesta tutkimuksesta, joissa tutkittiin virtuaalitodellisuusintervention tehokkuutta psykiatrian erityispalveluissa. Toisessa vaiheessa sähköisen päiväkirjan (e-päiväkirjan) käyttöä tutkittiin nuorisopsykiatrian poliklinikoilla masennusoireiden takia vuosina 2008–2010 asiakkaina olleiden nuorten (n=89) keskuudessa. Kolmannessa vaiheessa tutkittiin vuonna 2018 nuorille (n=2,193) suunnattujen verkkopohjaisten palvelujen käyttöä. Toisessa ja kolmannessa vaiheessa kvantitatiivisia tietoja analysoitiin kuvailevalla analyysillä ja kvalitatiivisia tietoja induktiivisella temaattisella analyysillä. Systemaattisen katsauksen ja meta-analyysin perusteella virtuaalitodellisuus-interventioiden hyödyistä tai haitoista vakavien mielenterveysongelmien hoidossa ei löytynyt laadukasta näyttöä. Nuorten pitkäaikainen e-päiväkirjan käyttö oli vähäistä ja lähes puolet osallistujista eivät käyttäneet sitä lainkaan. E-päiväkirjaa käyttäneillä oli aiempaa kokemusta mielenterveyspalveluista ja heillä oli vakavampia masennusoireita kuin heillä, jotka eivät sitä käyttäneet. Nuoret, jotka käyttivät digitaalisia teknologioita nuorisopsykiatrisen polikliinisen hoidon aikana tai verkkopohjaisissa palveluissa, olivat pääasiassa naispuolisia. Tämän tutkimuksen tulosten mukaan digitaalisia teknologioita käytettiin useimmiten iltaisin ja kouluvuoden aikana. Nuoret keskustelivat avoimesti mielenterveydestään ja henkilökohtaisista asioistaan, kuten ihmissuhteistaan, identiteetistään, sosiaalisesta elämästään, terveydestään ja sairauksistaan sekä miten he näkivät ja kokivat itsensä. Digitaaliset teknologiat luovat mahdollisuuksia auttaa nuoria seuraamaan käyttäytymistään, oireitaan tai kokemuksiaan sekä saamaan tukea, silloin kun he sitä tarvitsevat. Digitaaliseen teknologiaan perustuvaa tukea kehitettäessä ja toteutettaessa on tärkeää ottaa huomioon nuorten erilaiset mielenterveys- ja sukupuolikohtaiset tarpeet sekä heidän valmiutensa käyttää digitaalista teknologiaa oman mielenterveyden ja hyvinvoinnin tukemiseen

How do mobile devices support clinical work on hospital wards: an investigation of the selection and use of computing devices

The mobile and information intensive nature of clinical work in hospital settings presents a critical challenge: how to provide clinicians with access to information at the time and place of need? This challenge is particularly pertinent to decision-makers responsible for the selection of computing devices. Mobile devices are often promoted as a means to meet this challenge, with existing literature tending to portray the mobility of devices as inherently beneficial. However, evidence to clearly demonstrate how mobile devices support clinical work is limited. This research aimed to generate new knowledge to contribute to answering two significant questions: (i) how do decision-makers select computing devices? and (ii) how do mobile devices support clinical work practices? The research was conducted in two stages. In stage one, interviews were conducted with 28 individuals involved in decisions regarding the selection of computing devices for hospital wards. Decision-makers reported a range of factors that influenced device selection. Role of the user, types of tasks, and location of tasks, for example, were deemed important. In stage two, a mixed methods design comprising structured observations, interviews, and field notes was employed. A sample of 38 clinicians, on two wards of a metropolitan hospital, was observed for 90 hours. In total 4,423 clinical tasks were recorded, capturing key information about tasks doctors and nurses undertake, where, and devices used. The findings provide evidence validating core assumptions about mobile devices: namely, that they support clinicians work by facilitating access to information at patients bedsides. Notably, mobile devices also supported work away from the bedside and whilst clinicians were in transit, allowing continuity in work processes. However, mobile devices did not provide the best fit for all tasks and additional factors, such as the temporal rhythms of the ward and structure of ward round teams, affected how mobile devices supported work. Integration of findings from the two stages resulted in the development of a detailed list of factors that influence the use of mobile devices on hospital wards. This new evidence provides valuable knowledge to guide the selection of computing devices to support, and potentially optimise, clinical work

Maine State Government Administrative Report 1992-1993

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