Towards an evaluation framework for medical web applications

Copyright @ 2013 EMCIS.The main aim of this study is to review and analyse various evaluation frameworks used to assess the operational effectiveness of various Information Technology (IT) processes/applications and identify their strengths in order to form a new holistic framework for economic evaluation of web applications. This research aims to address the need for a new holistic evaluation framework for the purpose of the evaluation of the medical web applications. Over the last decade more and more, companies used accountancy techniques such as the frameworks analysed in this research. This new holistic framework that was developed will include also steps regarding the indirect and intangible costs and benefits identification and their incorporation in the evaluation process. Moreover the new emerging market of the medical websites and the embedded on them web applications requires also a new evaluation framework that will provide accurate results in the estimation of the efficiency of an investment on them. The paper first presents an introduction about why economic evaluation is important when evaluating the Information Technology in organizations. Various studies are reviewed, which highlight the ever increasing importance of integrating economic evaluation processes, such as Cost Benefit Analysis (CBA) and Return on Investment (ROI), into systems and processes of organizations and economic organizations, and analyse the factors that govern their role. Finally, the evaluation frameworks and methods that are found in these studies should be used as a part of a proactive systematic action plan that the organizations could use to avoid budget reduction due to incorrect planning. The next part of this study includes a comprehensive presentation and review of past frameworks used to evaluate Information Technology. The frameworks that are reviewed are the Framework for evaluation of information systems, the Information Technology Adoption Model (ITAM), the Total Evaluation and Acceptance Methodology (TEAM) framework, the ROI Process Model and HOT-fit evaluation framework for Health Information Systems

Acceptance of Health Information System for Public Health Centre in North Borneo, Indonesia

This study sought the factor associated with own acceptance of HIS for PHC by using the modification of Technology Acceptance Model (TAM) in the Sebengkok PHC, Central Tarakan Subdistrict, Tarakan City, North Borneo, Indonesia. A cross-sectional approach was conducted through a survey on the 37 of PHC\u27s user. A set of questionnaires which was adopted from the previous research was used to collect the information from the participant. The model was developed by involving job relevance, output quality, result demonstrability, screen design, terminology, facilitating condition, perceived of usefulness, perceived ease of use, intention to use and system use (actual usage) as the construct. According to the hypothesis testing, perceived usefulness predicted by terminology, perceived ease of use is significantly predicted by screen design and terminology, perceived usefulness significantly predicts the intention of use and perceived ease of use, while system use which predicted considerably by the intention of use and facilitating condition. This study may have a contribution to the future improvement of HIS for PHC and guide the next coming research to dig the difference acceptance among the user

Translation of evidence-based Assistive Technologies into stroke rehabilitation: Users' perceptions of the barriers and opportunities

Background: Assistive Technologies (ATs), defined as "electrical or mechanical devices designed to help people recover movement", demonstrate clinical benefits in upper limb stroke rehabilitation; however translation into clinical practice is poor. Uptake is dependent on a complex relationship between all stakeholders. Our aim was to understand patients', carers' (P&Cs) and healthcare professionals' (HCPs) experience and views of upper limb rehabilitation and ATs, to identify barriers and opportunities critical to the effective translation of ATs into clinical practice. This work was conducted in the UK, which has a state funded healthcare system, but the findings have relevance to all healthcare systems. Methods. Two structurally comparable questionnaires, one for P&Cs and one for HCPs, were designed, piloted and completed anonymously. Wide distribution of the questionnaires provided data from HCPs with experience of stroke rehabilitation and P&Cs who had experience of stroke. Questionnaires were designed based on themes identified from four focus groups held with HCPs and P&Cs and piloted with a sample of HCPs (N = 24) and P&Cs (N = 8). Eight of whom (four HCPs and four P&Cs) had been involved in the development. Results: 292 HCPs and 123 P&Cs questionnaires were analysed. 120 (41%) of HCP and 79 (64%) of P&C respondents had never used ATs. Most views were common to both groups, citing lack of information and access to ATs as the main reasons for not using them. Both HCPs (N = 53 [34%]) and P&C (N = 21 [47%]) cited Functional Electrical Stimulation (FES) as the most frequently used AT. Research evidence was rated by HCPs as the most important factor in the design of an ideal technology, yet ATs they used or prescribed were not supported by research evidence. P&Cs rated ease of set-up and comfort more highly. Conclusion: Key barriers to translation of ATs into clinical practice are lack of knowledge, education, awareness and access. Perceptions about arm rehabilitation post-stroke are similar between HCPs and P&Cs. Based on our findings, improvements in AT design, pragmatic clinical evaluation, better knowledge and awareness and improvement in provision of services will contribute to better and cost-effective upper limb stroke rehabilitation. © 2014 Hughes et al.; licensee BioMed Central Ltd

CoachAI: A Conversational Agent Assisted Health Coaching Platform

Poor lifestyle represents a health risk factor and is the leading cause of morbidity and chronic conditions. The impact of poor lifestyle can be significantly altered by individual behavior change. Although the current shift in healthcare towards a long lasting modifiable behavior, however, with increasing caregiver workload and individuals' continuous needs of care, there is a need to ease caregiver's work while ensuring continuous interaction with users. This paper describes the design and validation of CoachAI, a conversational agent assisted health coaching system to support health intervention delivery to individuals and groups. CoachAI instantiates a text based healthcare chatbot system that bridges the remote human coach and the users. This research provides three main contributions to the preventive healthcare and healthy lifestyle promotion: (1) it presents the conversational agent to aid the caregiver; (2) it aims to decrease caregiver's workload and enhance care given to users, by handling (automating) repetitive caregiver tasks; and (3) it presents a domain independent mobile health conversational agent for health intervention delivery. We will discuss our approach and analyze the results of a one month validation study on physical activity, healthy diet and stress management

Role of Computerized Physician Order Entry Usability in the Reduction of Prescribing Errors

Some hospitals have implemented computerized physician order entry (CPOE) systems to reduce the medical error rates. However, research in this area has been very limited, especially regarding the impact of CPOE use on the reduction of prescribing errors. Moreover, the past studies have dealt with the overall impact of CPOE on the reduction of broadly termed "medical errors", and they have not specified which medical errors have been reduced by CPOE. Furthermore, the majority of the past research in this field has been either qualitative or has not used robust empirical techniques. This research examined the impacts of usability of CPOE systems on the reduction of doctors' prescribing errors. Methods: One hundred and sixty-six questionnaires were used for quantitative data analyses. Since the data was not normally distributed, partial least square path modelling-as the second generation of multivariate data analyses-was applied to analyze data. Results: It was found that the ease of use of the system and information quality can significantly reduce prescribing errors. Moreover, the user interface consistency and system error prevention have a significant positive impact on the perceived ease of use. More than 50% of the respondents believed that CPOE reduces the likelihood of drug allergy, drug interaction, and drug dosing errors thus improving patient safety. Conclusions: Prescribing errors in terms of drug allergy, drug interaction, and drug dosing errors are reduced if the CPOE is not error-prone and easy to use, if the user interface is consistent, and if it provides quality information to doctors

Ensuring patients privacy in a cryptographic-based-electronic health records using bio-cryptography

Several recent works have proposed and implemented cryptography as a means to preserve privacy and security of patients health data. Nevertheless, the weakest point of electronic health record (EHR) systems that relied on these cryptographic schemes is key management. Thus, this paper presents the development of privacy and security system for cryptography-based-EHR by taking advantage of the uniqueness of fingerprint and iris characteristic features to secure cryptographic keys in a bio-cryptography framework. The results of the system evaluation showed significant improvements in terms of time efficiency of this approach to cryptographic-based-EHR. Both the fuzzy vault and fuzzy commitment demonstrated false acceptance rate (FAR) of 0%, which reduces the likelihood of imposters gaining successful access to the keys protecting patients protected health information. This result also justifies the feasibility of implementing fuzzy key binding scheme in real applications, especially fuzzy vault which demonstrated a better performance during key reconstruction

Older People, Telematics and Care

About the book: What are the implications of current economic, social and political trends in Britain for older people? Social and demographic changes have led to traditional areas of welfare being transformed. The contributors to this book take a critical look at the current situation and assess the implications for future practice. They debate the assumptions and values underlying established welfare programmes and consider the case for change as growing demands put health and social services under increasing pressure. The second part of the book discusses specific areas in detail, ranging from the organisation of effective domiciliary social care to the impact of new technologies on older people's lives. This book provides a comprehensive and practical overview of the provision of services for older people and will be a valuable and thought-provoking resource for anyone involved in caring for and supporting them

The client-oriented model of cultural competence in healthcare organizations

The paper aims to propose a new model of cultural competence in health organizations based on the paradigm of client orientation. Starting from a literature review, this study takes inspiration from dimensions that characterize the cultural competence of health organizations, and re-articulates them in more detail by applying a client orientation view. The resulting framework is articulated into six dimensions (formal references; procedures and practices; cultural competences of human resources; cultural orientation toward client; partnership with community; and self-assessment) that define the ability of a health organization to achieve its mission, acknowledging, understanding, and valorizing cultural differences of internal clients (staff) and external clients (consumers). This study makes an effort to address the paucity of studies linking approaches to managing cultural diversity in health organizations with cultural competence within the framework of client orientation

Evaluating the impact of physical activity apps and wearables: interdisciplinary review

Background: Although many smartphone apps and wearables have been designed to improve physical activity, their rapidly evolving nature and complexity present challenges for evaluating their impact. Traditional methodologies, such as randomized controlled trials (RCTs), can be slow. To keep pace with rapid technological development, evaluations of mobile health technologies must be efficient. Rapid alternative research designs have been proposed, and efficient in-app data collection methods, including in-device sensors and device-generated logs, are available. Along with effectiveness, it is important to measure engagement (ie, users’ interaction and usage behavior) and acceptability (ie, users’ subjective perceptions and experiences) to help explain how and why apps and wearables work. Objectives: This study aimed to (1) explore the extent to which evaluations of physical activity apps and wearables: employ rapid research designs; assess engagement, acceptability, as well as effectiveness; use efficient data collection methods; and (2) describe which dimensions of engagement and acceptability are assessed. Method: An interdisciplinary scoping review using 8 databases from health and computing sciences. Included studies measured physical activity, and evaluated physical activity apps or wearables that provided sensor-based feedback. Results were analyzed using descriptive numerical summaries, chi-square testing, and qualitative thematic analysis. Results: A total of 1829 abstracts were screened, and 858 articles read in full. Of 111 included studies, 61 (55.0%) were published between 2015 and 2017. Most (55.0%, 61/111) were RCTs, and only 2 studies (1.8%) used rapid research designs: 1 single-case design and 1 multiphase optimization strategy. Other research designs included 23 (22.5%) repeated measures designs, 11 (9.9%) nonrandomized group designs, 10 (9.0%) case studies, and 4 (3.6%) observational studies. Less than one-third of the studies (32.0%, 35/111) investigated effectiveness, engagement, and acceptability together. To measure physical activity, most studies (90.1%, 101/111) employed sensors (either in-device [67.6%, 75/111] or external [23.4%, 26/111]). RCTs were more likely to employ external sensors (accelerometers: P=.005). Studies that assessed engagement (52.3%, 58/111) mostly used device-generated logs (91%, 53/58) to measure the frequency, depth, and length of engagement. Studies that assessed acceptability (57.7%, 64/111) most often used questionnaires (64%, 42/64) and/or qualitative methods (53%, 34/64) to explore appreciation, perceived effectiveness and usefulness, satisfaction, intention to continue use, and social acceptability. Some studies (14.4%, 16/111) assessed dimensions more closely related to usability (ie, burden of sensor wear and use, interface complexity, and perceived technical performance). Conclusions: The rapid increase of research into the impact of physical activity apps and wearables means that evaluation guidelines are urgently needed to promote efficiency through the use of rapid research designs, in-device sensors and user-logs to assess effectiveness, engagement, and acceptability. Screening articles was time-consuming because reporting across health and computing sciences lacked standardization. Reporting guidelines are therefore needed to facilitate the synthesis of evidence across disciplines