ACCEPTANCE AND BARRIER OF ELECTRONIC HEALTH RECORDS IN A TERTIARY HOSPITAL IN NIGERIA

Purpose: This study assesses the performance, determine the barriers and effects of electronic health records on the staff of Obafemi Awolowo Teaching Hospital, Ile-Ife, Osun State, Nigeria. Method/Approach: This study was designed to explore the experiences of staff that practised a computerized or electronic health record in Obafemi Awolowo Teaching Hospital, Osun State, Nigeria (OAUTH). This study utilized a quantitative method. The study sample includes 10 respondents from the intensive care unit, 40 respondents from the health information department, 25 respondents from nurses and 25 respondents from the medical doctors of the hospital. The respondents were purposively selected and the instrument (questionnaire) was administered using the random sampling technique. Findings/results: This study showed that there is a high performance (80%) of EHR in the hospital. Most respondents (65%) opined that EHR is easy to use. The assessment of the respondents about the ability of EHR to reduce medical error revealed that about 75% said EHR will reduce medical error. In addition to this, about 80% of the respondents said EHR is important in the transmission of patient prescription. The barrier to the implementation of electronic health record includes an inadequate computer (50%), lack of uniform hospital standard (55%), start-up financial costs (60%) and training and productivity loss. Recommendation: The hospital management, federal and state government and non-governmental organizations should work together to remove all barrier to the implementation of electronic health records through the provision of computer systems, finance, stable electricity supply, man-power training and employment of adequate staff. Article visualizations

Revealing the Root Causes of Digital Health Data Quality Issues: A Qualitative Investigation of the Odigos Framework

Digital health data quality is a critical concern in the healthcare industry, jeopardizing the secondary use of data for revolutionizing population health, and hindering patient care and organizational outcomes. Limited published evidence exists for explaining why these data quality issues emerge. The Odigos framework is a notable exception asserting that data quality issues emerge from three worlds: material world (e.g., technology artifact), personal world (e.g., technology users/use), and social world (e.g., organizations/ institutions) but has yet to systematically unpack the elements within these worlds. Through deductive and inductive analysis of interview data from a case study of the Emergency Department of Australia’s first large digital hospital, we apply and extend the Odigos framework by identifying elements emanating from the three worlds and their interrelationships as root causes of data quality issues. These elements can then be used by hospitals to develop strategies to proactively improve their digital health data quality

Automating Electronic Health Record Data Quality Assessment

Information systems such as Electronic Health Record (EHR) systems are susceptible to data quality (DQ) issues. Given the growing importance of EHR data, there is an increasing demand for strategies and tools to help ensure that available data are fit for use. However, developing reliable data quality assessment (DQA) tools necessary for guiding and evaluating improvement efforts has remained a fundamental challenge. This review examines the state of research on operationalising EHR DQA, mainly automated tooling, and highlights necessary considerations for future implementations. We reviewed 1841 articles from PubMed, Web of Science, and Scopus published between 2011 and 2021. 23 DQA programs deployed in real-world settings to assess EHR data quality (n = 14), and a few experimental prototypes (n = 9), were identified. Many of these programs investigate completeness (n = 15) and value conformance (n = 12) quality dimensions and are backed by knowledge items gathered from domain experts (n = 9), literature reviews and existing DQ measurements (n = 3). A few DQA programs also explore the feasibility of using data-driven techniques to assess EHR data quality automatically. Overall, the automation of EHR DQA is gaining traction, but current efforts are fragmented and not backed by relevant theory. Existing programs also vary in scope, type of data supported, and how measurements are sourced. There is a need to standardise programs for assessing EHR data quality, as current evidence suggests their quality may be unknown

Data quality in health research: the development of methods to improve the assessment of temporal data quality in electronic health records

Background: Electronic health records (EHR) are increasingly used in medical research, but the prevalence of temporal artefacts that may bias study findings is not widely understood or reported. Furthermore, methods aimed at efficient and transparent assessment of temporal data quality in EHR datasets are unfortunately lacking. Methods: 7959 time series representing different measures of data quality were generated from eight different EHR data extracts covering activity between 1986-2019 at a large UK hospital group. These time series were visually inspected and annotated via a citizen-science crowd-sourcing platform, and consensus labels for the locations of all change points (i.e. places where the distribution of data values changed suddenly and unpredictably) were constructed using density-based clustering with noise. The crowd-sourced consensus labels were validated against labels produced by an experienced data scientist, and a diverse range of automated change point detection methods were assessed for accuracy against these consensus labels using a novel approximation to a binary classifier. Lastly, an R package was developed to facilitate assessment of temporal data quality in EHR datasets. Results: Over 2000 volunteers participated in the citizen-science project, performing 341,800 visual inspections of the time series. A total of 4477 distinct change points were identified across the eight data extracts, covering almost every year of data and virtually all data fields. Compared to expert labels, accuracy of crowd-sourced consensus labels identifying the locations of individual change points had high sensitivity 80.4% (95% CI 77.1, 83.3), specificity 99.8% (99.7, 99.8), positive predictive value (PPV) 84.5% (81.4, 87.2) and negative predictive value (NPV) 99.7% (99.6, 99.7). Automated change point detection methods failed to detect the crowd-sourced change points accurately, with maximum sensitivity 36.9% (35.2, 38.8), specificity 100% (100, 100), PPV 51.6% (49.4, 53.8), and NPV 99.9% (99.9, 99.9). Conclusions: This large study of real-world EHR found temporal artefacts occurred with very high frequency, which could impact findings from analyses using these data. Crowd-sourced labels of change points compared favourably to expert labels, but currently-available automated methods performed poorly at identifying such artefacts when compared to human visual inspection. To improve reproducibility and transparency of studies using EHRs, thorough visual assessment of temporal data quality should be conducted and reported, which can be assisted by tools such as the new daiquiri R package developed as part of this thesis