Evaluation of Young Adults' Preferences, Needs, and the Understandability of the Personal Health Record Data Contents

This research study examines Personal Health Records (PHRs), focusing on the issues of data contents from the end users' perspectives. The study evaluates the understandability of the Continuity of Care Record (CCR) standard terminology currently used in PHR system and explores users' preferences and needs for data contents.PHRs are becoming an increasingly important and popular means of enabling individuals to have more direct and stronger ownership and management of their health information. One of the potential barriers to the PHRs adoption is the usability of the system, particularly the fact that PHR data contents contain difficult terminology and does not meet the users' needs and preferences. A review of currently available PHR systems shows that vendors are trying to design a comprehensive PHRs primarily based on data contents from the health providers' perspectives, especially the CCR standard. However, this comprehensive data set may be neither suitable nor appealing to most individuals with a busy schedule. Therefore, this research aims at identifying the needs and preferences of the primary users of PHRs with the ultimate goal of designing a user-friendly PHR system that caters to the specific and individual needs of a healthy young adult population.  A mixed-method of qualitative and quantitative research in the form of an exploratory-descriptive study was conducted to examine the individual's needs in terms of PHR contents and terminology. Data was collected through an in-depth, semi-structured interview. Furthermore, a qualitative review study was conducted to identify each data element in the currently available free and for-purchase PHR systems and compare those with the CCR. The PHR included in this study were randomly chosen from the list of PHR tools and services available at www.myphr.com. The results of this research provide insight for PHR developers, enabling them to better design and tailor PHR technology in order to fulfill the needs and desires of each specific individual group and subgroup. A PHR system tailored to the user's individualized needs will serve to make the user feel more comfortable using and maintaining it, and then could lead to wider adoption of PHR within the population

Trajectories of alcohol-related harm among young people

In many high-income countries such as Australia, alcohol use has declined in young people since the early 2000s but there is conflicting evidence around reductions in alcohol-related harm. A key issue around quantifying alcohol-related harm is that different data sources can show vastly different patterns due to varying sample characteristics or methods of measurement. The studies comprising this thesis aimed to address these gaps by using a variety of data sources to examine: 1) trends in self-reported harms across age, period, and birth cohort using national surveys (n=121,281); 2) developmental patterns of blackouts, a very common harm, and predictors of high-risk patterns in a recent birth cohort (n=1,821); 3) developmental transitions between different types of alcohol-related harm and predictor of high-risk patterns in a recent birth cohort (n=1,828); and 4) risk factors for experiencing clinical alcohol-related harm for the first time at a younger age and compare rates of subsequent harm by age at first experience of clinical harm in a linked cohort (n=10,300). Several notable findings were identified. National data indicate that alcohol-related risky behaviours are much less common in recent birth cohorts, though they continue to be most prevalent in young people. Males generally had twice the prevalence of risky behaviours compared to females, but with reduced effect among more recent birth cohorts. Longitudinal cohort data indicated that escalating experience of harms, particularly blackouts and psychosocial harms (e.g., getting into fights) increased risk of early adulthood alcohol use disorder symptoms. Females were at higher risk of experiencing physiological harms such as blackouts earlier in life compared to males. Finally, analyses of linked hospital service data indicated that females were at higher risk of accessing hospital services for an alcohol-related problem for the first time at a younger age. Younger people were more likely to have subsequent injury-related ED presentations but less likely to be hospitalised. Past year hospital service access rates in this cohort were much higher than the same-aged general population. This thesis highlights important developments in young peoples’ experience of alcohol-related harm. The identification of a closing male-female gap in harms and of female status as a risk factor for early harm warrants future research and shifts to the approach of harm reduction and prevention among young people

Secondary use of electronic medical records for early identification of raised condition likelihoods in individuals: a machine learning approach

With many symptoms being common to multiple diseases, there is a challenge in producing an initial diagnosis or recommendation for diagnostic tests from a set of symptoms that could have been produced by a number of diseases. Often the initial choice of diagnosis or testing is based on a clinician’s impression of the likelihood of that condition in a general population; however the opportunity may exist for modification of these likelihoods based on individuals’ recorded medical histories. This data-driven approach utilises existing data and is thus cheap and non-invasive. A method is proposed by which an individual’s likelihoods of having specified medical conditions are modified by the similarity of that individual’s medical history to the medical histories of other individuals, comparing the prevalence of conditions in those other individuals’ records who are similar to the individual of interest versus the prevalence of the conditions in those individuals who are dissimilar. In order to maximise the number of records available for analysis, a process was developed for the merging of data from disparate sources that used different clinical coding systems, including extensive development of a technique for semi automatically mapping clinical events coded in ICD9-CM to Clinical Terms Version 3 (CTV3), for which no existing mapping table was found. Semantically similar fields in the source code sets were identified and retained in the combined data set. ‘Codelists’ comprising multiple CTV3 codes for a variety of conditions were built that defined the presence of those conditions within individual records. The hierarchical structure of the CTV3 code table was utilised as a method of identifying codes that differed in structure but had clinically similar or related meaning. The optimum degree of granularity of the coded data to use in identifying similar records was investigated and used in subsequent analysis. Two methods were used for discovering groups of similar and dissimilar individuals: the ‘nearest neighbours’ method and the grouping of records using a clustering process. Altered likelihoods for a range of conditions were investigated and results for the nearest-neighbours approach compared to the clustering approach. Results for adjusted condition likelihoods for 18 conditions are reported, together with a discussion of possible reasons for a change, or otherwise, in the condition likelihood, and a discussion of the clinical significance and potential use of information about such a change. logistic regressions performed on a selection of conditions KNN performed better than logistic regression when judged by F-score (or sensitivity and specificity separately), however situation more nuanced when looking at likelihood ratios: Logistic regression produced higher (better) positive likelihood ratios, but KNN produced lower (better) negative likelihood ratios. Logistic regression produced higher odds ratios

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

Electronic medical records in paediatric ophthalmology: a study of potential users and uses to inform design

Electronic medical records are at the core of an advancing movement toward information-driven healthcare. By enhancing abilities to capture, store, and analyse vast amounts of health data, the routine use of electronic medical records is advocated as a means to improve the efficiency and quality of care provision, advance population health, empower patients, and reduce healthcare costs. However, the delivery of any benefits is threatened by a failure to understand the unique care environments of different clinical specialties, and to appropriately customise system design. This has prompted a move to the user-centred design process of health information technology. Paediatric ophthalmology is a unique field that faces particular challenges in electronic medical record adoption. As with other ophthalmic specialties, the heavy use of imaging and diagrammatic documentation is difficult to replicate electronically. As is the flexibility required to meet the demands incurred by the varying ages, developmental stages, and visual needs of each patient, reflecting a unique interface between the ophthalmic and paediatric requirements. The consideration of such requirements is essential throughout the user-centred design of effective health information technology systems. However, paucity in the evidence base surrounding electronic medical record design methodologies and system usage hinders technological development and application within paediatric ophthalmology. This research was centred on a user-centred design process, to provide an understanding of the users of electronic medical records in paediatric ophthalmology, and their requirements. Taking a mixed methods approach, this research initially explored the landscape of medical record use – gathering user- centred requirements – and concluded with the development and testing of three prototype data collection forms, for specific use cases within paediatric ophthalmology. Overall, this work articulates the specific challenges and requirements in this area, and provides the foundation for future design and adoption strategies of electronic medical record systems within paediatric ophthalmology

Is South Africa ready for a national Electronic Health Record (EHR)?

Bibliography: leaves 94-100eHealth Strategies in countries have shown a trend that countries are moving to Electronic Health Records(EHR). EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. The use of some format of an Electronic Health Record is used by many countries and others are in the implementation or planning phases. South Africa has kicked of the project to implement a national EHR as part of the national eHealth Strategy. This study aims to analyse the key success factors from other EHR implementation projects and evaluate if South Africa is ready to implement an EHR.Graduate School of Business LeadershipMB

SUPPORTING ENGINEERING DESIGN OF ADDITIVELY MANUFACTURED MEDICAL DEVICES WITH KNOWLEDGE MANAGEMENT THROUGH ONTOLOGIES

Medical environments pose a substantial challenge for engineering designers. They combine significant knowledge demands with large investment for new product development and severe consequences in the case of design failure. Engineering designers must contend with an often-chaotic environment to which they have limited access and familiarity, a user base that is difficult to engage and highly diverse in many attributes, and a market structure that often pits stakeholders against one another. As medical care in general moves towards personalized models and surgical tools towards less invasive options emerging manufacturing technologies in additive manufacturing offer significant potential for the design of highly innovative medical devices. At the same time however these same technologies also introduce yet more challenges to the design process. This dissertation presents a knowledge-based approach to addressing the existing and emerging challenges of medical device design. The approach aims to address these challenges using knowledge captured in a suite of modular ontologies modeling knowledge domains that must be considered in medical device design. These include ontologies for understanding clinical context, human factors, regulation, enterprise, and manufacturability. Together these ontologies support design ideation, knowledge capture, and design verification. These ontologies are subsequently used to formulate a comprehensive knowledge framework for medical device design, and to enable an innovative design process. Case studies analyzing the design of surgical tools in several medical specialties are used to assess the capabilities of this approach