The evaluation of the electronic prescription service in primary care: final report on the findings from the evaluation in early implementer sites

This report presents the findings from The Evaluation of the Electronic Prescription Service in Primary Care, a Connecting for Health Evaluation Programme commissioned project. The projects aim, as stated in the proposal, was to evaluate Phase 3 (Release 2) of the Electronic Prescription Service (hereafter EPS R2) to determine effects on patient safety, satisfaction with care, work processes and economics. The methods used were a blend of ethnographically informed quantitative and qualitative approaches

A Two-Level Information Modelling Translation Methodology and Framework to Achieve Semantic Interoperability in Constrained GeoObservational Sensor Systems

As geographical observational data capture, storage and sharing technologies such as in situ remote monitoring systems and spatial data infrastructures evolve, the vision of a Digital Earth, first articulated by Al Gore in 1998 is getting ever closer. However, there are still many challenges and open research questions. For example, data quality, provenance and heterogeneity remain an issue due to the complexity of geo-spatial data and information representation. Observational data are often inadequately semantically enriched by geo-observational information systems or spatial data infrastructures and so they often do not fully capture the true meaning of the associated datasets. Furthermore, data models underpinning these information systems are typically too rigid in their data representation to allow for the ever-changing and evolving nature of geo-spatial domain concepts. This impoverished approach to observational data representation reduces the ability of multi-disciplinary practitioners to share information in an interoperable and computable way. The health domain experiences similar challenges with representing complex and evolving domain information concepts. Within any complex domain (such as Earth system science or health) two categories or levels of domain concepts exist. Those concepts that remain stable over a long period of time, and those concepts that are prone to change, as the domain knowledge evolves, and new discoveries are made. Health informaticians have developed a sophisticated two-level modelling systems design approach for electronic health documentation over many years, and with the use of archetypes, have shown how data, information, and knowledge interoperability among heterogenous systems can be achieved. This research investigates whether two-level modelling can be translated from the health domain to the geo-spatial domain and applied to observing scenarios to achieve semantic interoperability within and between spatial data infrastructures, beyond what is possible with current state-of-the-art approaches. A detailed review of state-of-the-art SDIs, geo-spatial standards and the two-level modelling methodology was performed. A cross-domain translation methodology was developed, and a proof-of-concept geo-spatial two-level modelling framework was defined and implemented. The Open Geospatial Consortium’s (OGC) Observations & Measurements (O&M) standard was re-profiled to aid investigation of the two-level information modelling approach. An evaluation of the method was undertaken using II specific use-case scenarios. Information modelling was performed using the two-level modelling method to show how existing historical ocean observing datasets can be expressed semantically and harmonized using two-level modelling. Also, the flexibility of the approach was investigated by applying the method to an air quality monitoring scenario using a technologically constrained monitoring sensor system. This work has demonstrated that two-level modelling can be translated to the geospatial domain and then further developed to be used within a constrained technological sensor system; using traditional wireless sensor networks, semantic web technologies and Internet of Things based technologies. Domain specific evaluation results show that twolevel modelling presents a viable approach to achieve semantic interoperability between constrained geo-observational sensor systems and spatial data infrastructures for ocean observing and city based air quality observing scenarios. This has been demonstrated through the re-purposing of selected, existing geospatial data models and standards. However, it was found that re-using existing standards requires careful ontological analysis per domain concept and so caution is recommended in assuming the wider applicability of the approach. While the benefits of adopting a two-level information modelling approach to geospatial information modelling are potentially great, it was found that translation to a new domain is complex. The complexity of the approach was found to be a barrier to adoption, especially in commercial based projects where standards implementation is low on implementation road maps and the perceived benefits of standards adherence are low. Arising from this work, a novel set of base software components, methods and fundamental geo-archetypes have been developed. However, during this work it was not possible to form the required rich community of supporters to fully validate geoarchetypes. Therefore, the findings of this work are not exhaustive, and the archetype models produced are only indicative. The findings of this work can be used as the basis to encourage further investigation and uptake of two-level modelling within the Earth system science and geo-spatial domain. Ultimately, the outcomes of this work are to recommend further development and evaluation of the approach, building on the positive results thus far, and the base software artefacts developed to support the approach

Комплексный анализ процессов интеграции информационных технологий в медицинские организации

Nowadays Information Technologies (IT) are taking more and more stable position in the process of work organization in various companies, and particularly among medical organizations. Present-day scientific society has already begun to research the topic of IT integration particularities into the Health organizations. Current article is focused on this issue. Our team has planned and provided a systematic review to understand which barriers can appear in different medical centers during implementation of the innovative IT into working process. The review has been fulfilled according to the designed protocol based on the actual recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. In the course of the workflow we have explored 2050 articles complied with the requirements. As a result, 23 key publications have been chosen and analyzed in detail. After considering the list of issues and barriers associated with the IT Implementation into hospitals and medical centers have been highlighted and described. We have classified them to notional clusters depending on the reasons of their appearance as well. In addition our team has defined the list of practical recommendations following which the result of the IT integration will be improved, but the risk of a negative outcome in the future can be eliminated.На современном этапе технологического развития информационные технологии (ИТ) закономерно занимают стабильную позицию в организации работы различных предприятий, в частности медицинских организаций. В мировом научном сообществе все больше внимания уделяется особенностям интеграции ИТ в медицинскую среду, на этом вопросе и сфокусировано внимание авторов данной статьи. Нашим научным коллективом был спланирован и проведен систематический обзор, целью которого было получить ответ на поставленный исследовательский вопрос: с какими проблемами могут столкнуться организации здравоохранения в процессе внедрения новых медицинских информационных технологий? Выполнение обзора осуществлялось по разработанному протоколу исследования в соответствии с актуальными рекомендациями Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. В ходе последовательно проведенных этапов работы из 2050 обнаруженных статей было отобрано 23 ключевых статьи и проведен их детальный анализ. В итоге были выделены, классифицированы и описаны барьеры, препятствующие успешному внедрению ИТ в учреждения здравоохранения. Кроме того, составлен список практических рекомендаций, выполнение которых, вероятно, приведет к повышению уровня внедрения технологии, а также позволит снизить риск непринятия технологии в долгосрочном периоде

Usability problems do not heal by themselves : National survey on physicians' experiences with EHRs in Finland

Purpose: Survey studies of health information systems use tend to focus on availability of functionalities, adoption and intensity of use. Usability surveys have not been systematically conducted by any healthcare professional groups on a national scale on a repeated basis. This paper presents results from two cross-sectional surveys of physicians' experiences with the usability of currently used EHR systems in Finland. The research questions were: To what extent has the overall situation improved between 2010 and 2014? What differences are there between healthcare sectors? Methods: In the spring of 2014, a survey was conducted in Finland using a questionnaire that measures usability and respondents' user experiences with electronic health record (EHR) systems. The survey was targeted to physicians who were actively doing clinical work. Twenty-four usability-related statements, that were identical in 2010 and 2014, were analysed from the survey. The respondents were also asked to give an overall rating of the EHR system they used. The study data comprised responses from 3081 physicians from the year 2014 and from 3223 physicians in the year 2010, who were using the nine most commonly used EHR system brands in Finland. Results: Physicians' assessments of the usability of their EHR system remain as critical as they were in 2010. On a scale from 1 ('fail') to 7 ('excellent') the average of overall ratings of their principally used EHR systems varied from 3.2 to 4.4 in 2014 (and in 2010 from 2.5 to 4.3). The results show some improvements in the following EHR functionalities and characteristics: summary view of patient's health status, prevention of errors associated with medication ordering, patient's medication list as well as support for collaboration and information exchange between the physician and the nurses. Even so, support for cross-organizational collaboration between physicians and for physician-patient collaboration were still considered inadequate. Satisfaction with technical features had not improved in four years. The results show marked differences between the EHR system brands as well as between healthcare sectors (private sector, public hospitals, primary healthcare). Compared to responses from the public sector, physicians working in the private sector were more satisfied with their EHR systems with regards to statements about user interface characteristics and support for routine tasks. Overall, the study findings are similar to our previous study conducted in 2010. Conclusions: Surveys about the usability of EHR systems are needed to monitor their development at regional and national levels. To our knowledge, this study is the first national eHealth observatory questionnaire that focuses on usability and is used to monitor the long-term development of EHRs. The results do not show notable improvements in physician's ratings for their EHRs between the years 2010 and 2014 in Finland. Instead, the results indicate the existence of serious problems and deficiencies which considerably hinder the efficiency of EHR use and physician's routine work. The survey results call for considerable amount of development work in order to achieve the expected benefits of EHR systems and to avoid technology-induced errors which may endanger patient safety. The findings of repeated surveys can be used to inform healthcare providers, decision makers and politicians about the current state of EHR usability and differences between brands as well as for improvements of EHR usability. This survey will be repeated in 2017 and there is a plan to include other healthcare professional groups in future surveys. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.Peer reviewe

Machina ex deos. Successes and challenges of implementing mobile computing technologies for development. The experience of nine Indian village health projects using a project-issued mobile application

As mobile computing technologies become increasingly functional and affordable, global donor and local development organizations find ways to justify and fund their use in grassroots development work. This dissertation asks two questions: (1) In resource-constrained social sector settings, what project features govern and structure use of work-issued mobile devices? And: (2) How do decision-makers adjust to maximize the benefit of newly-introduced devices while minimizing new burdens to the project and project staff? More simply, what variables under social sector projects’ control might promote successful use of information and communication technologies in development (ICTD) projects? This research represents systematic, qualitative comparison of nine extended deployments of a popular mobile health application, CommCare. Each studied project deployed devices loaded with CommCare to health workers in India as a supportive job aid and/or a data collection tool to help monitor beneficiary populations’ health status and frontline workers’ work. This dissertation examines the conditions under which these health workers were able and willing to use CommCare devices in their jobs, and whether and how they deviated from the use of those devices prescribed by their supervisors. Primary data for this study come from 62 in-depth, semi-structured interviews, extensive review of project documents, and personal observations from field study in India over six months in 2013. Employing a sociotechnical lens and a principal agent model, my data support expectations that use of CommCare devices would help align community health workers’ behavior with their supervisors’ organization and mission-related priorities. Use of the devices improved health workers’ professional competence and improved communications, data quality, and data access. These improvements facilitated project supervisors’ monitoring of health workers and beneficiaries, and funders’ monitoring of projects. Contradicting expectations, use of CommCare devices also weakened organizational oversight and control through new data challenges and increased health worker autonomy in their personal and professional lives. These dual benefits and challenges ultimately served the overall projects’ missions.Public Affair

Architecting the future telebehavioral health system of care in the Army

Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, 2012.Cataloged from PDF version of thesis.Includes bibliographical references (p. 151-159).Charged by the Chairman of the Joints Chief of Staff, the authors were members of a study to develop innovative recommendations for transforming the military enterprise to better manage post-traumatic stress and related conditions in support of service members and their families. The authors first began their study by performing a stakeholder analysis to understand the unmet needs of stakeholders across the enterprise. By assessing stakeholder values across the life cycle, we found that there was a strong need to improve the continuity of care and accessibility of services for service members and their families, in particular for the Reserve Component and National Guard population. Therefore, the authors investigated the role of technology to serve as a force extender to improve access and timeliness of care to psychological health care services. Specifically, they utilized a systems approach to evaluate the current state of telehealth within the Military Health System. By utilizing the enterprise lenses of strategy, policy, organization, services, processes, infrastructure, and knowledge to analyze the current state of telebehavioral health, they proposed a future state architecture for telehealth delivery. They highlight seven enterprise requirements for developing this future state architecture: 1. MEDCOM shall establish a core funding stream as a line item to support TH service line. 2. MEDCOM Telehealth Service line shall develop standard TBH metrics for deployment across the enterprise 3. MEDCOM Telehealth Service line shall identify eligible populations across the enterprise that could benefit from the expanded access that TBH services provide. 4. MEDCOM Telehealth Service line shall develop an enterprise solution that supports seamless flow of operational information and the electronic health record. 5. MEDCOM Telehealth Service line shall revisit specific policies that are presenting barriers to telehealth growth and sustainability. 6. MEDCOM Telehealth Service line shall encourage learning and best practice sharing across the Army TH enterprise. 7. MEDCOM Telehealth Service line shall collaborate with other Army governance organizations to develop a mobile health strategy and pilot projects for the Army enterprise.by Andrea K. Ippolito.S.M