Healthcare 4.0 digital technologies impact on quality of care: A systematic literature review

The healthcare industry is transforming into Healthcare 4.0 (H4.0), an era characterized by smart and connected healthcare systems. This study presents a conceptual framework that classifies H4.0 digital technologies into information and communication technology bundles within the healthcare value chain. It also identifies barriers and evaluates digital technologies’ impact on quality measures through a systematic literature review and meta-analysis approach following the PRISMA protocol. The analysis reveals that digital technologies in the healthcare sector traditionally consist of sensing-communication and processing-actuation technologies. The findings highlight the significant influence of H4.0 digital technologies on three quality measures: patient safety, patient experience/ satisfaction, and clinical effectiveness. While these technologies offer potential benefits, they pose challenges for patients and clinicians, including intellectual property and significance concerns, especially in North America. The proposed framework addresses these issues and enables stakeholders to prioritize, review, and analyze H4.0 digital technologies to enhance patient safety, experience, and clinical effectiveness. This research contributes to the existing literature by being the first comprehensive analysis of the impact of H4.0 technologies on the quality of care. The framework provided in this study offers valuable guidance for stakeholders in selecting appropriate technologies to improve patient outcomes and support the healthcare value chain

New York\u27s Delivery System Reform Incentive Payment (DSRIP) Program: How DSRIPtive will this $8 Billion Initiative Be?

For over 30 years, James B. Couch, M.D., J.D., FACPE, has been a practicing physician, attorney and senior executive for leading health care, financial, legal and professional services organizations. He has devoted his career to quality and patient safety, especially where the practices and principles of medicine, law, information technology, business and risk management merge. Dr. Couch’s Forum presentation will address what the NY Delivery System Reform Incentive Payment (DSRIP) program is and why it is important to healthcare transformation. He will discuss how the key principles and projects of the NY DSRIP program may combine to promote achievement of the Quadruple Aim. Lastly, Dr. Couch will describe how NY DSRIP’s performance-based funds flow to Performing Provider Systems (PPS) and impact health systems. Dr. Couch has worked extensively in evaluating and positioning leading edge cloud-based electronic health information systems, clinical and population health analytics products for use by top healthcare providers and payers. Couch has published on the development of accountable care capable organizations, and the use of disease and population health management methodologies and health IT to continuously improve patient safety and healthcare quality. Presentation: 54 minutes PowerPoint slides at bottom of pag

Information Governance: An Investigation of Interface Errors Between Source and Receiving Systems

The monitoring of interoperability of information in healthcare organizations is of increasing interest due to patient safety, operational and financial considerations. This monitoring is referred to as information governance (IG) and is a complex topic based on several underlying concepts. Interfacing information at the foundational, structural and semantic level is necessary for meaningful use of health information. Issues that arise range from incongruent transfer of information from source systems to receiving systems, discrepancies in the source system and receiving system and failures in interfacing information. This research project examines information governance from the perspective of failures in interfacing information from the perspective of people, process and technology in monitoring interface errors between health information systems. The research design is evaluation and the methodology is case study in order to evaluate the effectiveness of interfaces between source and receiving systems. Particularly 17 Health Level Seven (HL7) interfaces were reviewed within a Critical Access Hospital (CAH) to investigate information governance from a people, process and technology perspective. This case study helped to identify needed information governance within the organization and plan for implementation of an information governance committee in order to address foundational and structural issues and to monitor unintended consequences caused by interface errors in the areas of patient safety, operational and financial impact due to interface errors

Electronic Health Records Functionalities and Quality of Care: Conceptual Model and Research Agenda

There currently exists a rich stream of literature dedicated to exploring how different electronic health records (EHR) functionalities, such as Clinical Decision Support Systems (CDSS), Computerized Physician Order Entry (CPOE), and Health Information Exchange (HIE), improve various aspects of hospital performance. The purpose of this work is to summarize current state of the art and present a conceptual model that demonstrates dependencies between different functionalities of EHR and their impact on healthcare quality measures. In addition, we are creating a research agenda for future studies. We searched studies published between 2010 and 2020 in databases such Business Complete Source, Web of Science, and Google Scholars. Our initial search covers 52 studies published in journals such as Information Systems Journal, Health Affairs, Journal of Health Economics, Production and Operations Management, Decision Support Systems, Management Science, Journal of Operations Management, and others. We are also using a snowball sampling to identify more studies for our conceptual model. Identified studies indicated the relationships between different functionalities of EHR and various measures of quality of care. We used Donabedian’s (2005) approach of evaluating the quality of care to classify different areas in hospital improvements that we identified in our literature review. Donabedian’s framework categorizes quality of care measures by three groups: structure, process, and outcomes. Structural measures reflect the context in which healthcare service are delivered. These are mainly physical and organizational characteristics of hospitals. Furthermore, process measures reflect the interactions between patients and health providers. These measures demonstrate how care is delivered and the manner is which care is delivered. Finally, outcome measures indicate the impact of healthcare services on patients’ health status. Our conceptual model delineates the relationship between EHR functionalities, such as CPOE, CDSS, and HIE, and different structural measures (healthcare spending, return on investment, hospital efficiency, patient safety events), process measures (healthcare delivery, productivity of healthcare providers, patient care coordination, process compliance), and outcome measures (readmissions, patient mortality, patient morbidity, and patient satisfaction). Various theoretical perspectives were used to guide most of the studies: transaction cost economics, dynamic capabilities, resource-based view, task-technology fit theory, cybernetic control theory, information processing theory, agency theory, adaptive structuration theory, and others. We conclude this conceptual work by presenting a research agenda for future theoretical and empirical studies

VizCom: A Novel Workflow Model for ICU Clinical Decision-Support

The Intensive Care Unit (ICU) has the highest annual mortality rate (4.4M) of any hospital unit or 25% of all clinical admissions. Studies show a relationship between clinician cognitive load and workflow, and their impact on patient safety and the subsequent occurrence of medical mishaps due to diagnostic error - in spite of advances in health information technology, e.g., bedside and clinical decision support (CDS) systems. The aim of our research is to: 1) investigate the root causes (underlying mechanisms) of ICU error related to the effects of clinical workflow: medical cognition, team communication/collaboration, and the use of diagnostic/CDS systems and 2) construct and validate a novel workflow model that supports improved clinical workflow, with goals to decrease adverse events, increase safety, and reduce intensivist time, effort, and cognitive resources. Lastly, our long-term objective is to apply data from aims one and two to design the next generation of diagnostic visualization-communication (VizCom) system that improves intensive care workflow, communication, and effectiveness in healthcare

Developing a theoretical model and questionnaire survey instrument to measure the success of electronic health records in residential aged care

Electronic health records (EHR) are introduced into healthcare organizations worldwide to improve patient safety, healthcare quality and efficiency. A rigorous evaluation of this technology is important to reduce potential negative effects on patient and staff, to provide decision makers with accurate information for system improvement and to ensure return on investment. Therefore, this study develops a theoretical model and questionnaire survey instrument to assess the success of organizational EHR in routine use from the viewpoint of nursing staff in residential aged care homes. The proposed research model incorporates six variables in the reformulated DeLone and McLean information systems success model: system quality, information quality, service quality, use, user satisfaction and net benefits. Two variables training and self-efficacy were also incorporated into the model. A questionnaire survey instrument was designed to measure the eight variables in the model. After a pilot test, the measurement scale was used to collect data from 243 nursing staff members in 10 residential aged care homes belonging to three management groups in Australia. Partial least squares path modeling was conducted to validate the model. The validated EHR systems success model predicts the impact of the four antecedent variablesÐtraining, self-efficacy, system quality and information qualityÐon the net benefits, the indicator of EHR systems success, through the intermittent variables use and user satisfaction. A 24-item measurement scale was developed to quantitatively evaluate the performance of an EHR system. The parsimonious EHR systems success model and the measurement scale can be used to benchmark EHR systems success across organizations and units and over time

E-Healthcare Using Block Chain Technology and Cryptographic Techniques: A Review

The potential of information technology has influenced the efficiency and quality of healthcare worldwide. Currently, several republics are incorporating electronic health records (EHRs). Due to reluctance of technological adaptation & implementational complexities, electronic health record systems are not in practice. Due to the emphasis on achieving general compatibility, users may perceive systems as being imposed and providing insufficient customizability, which may exacerbate issues in a setting of national implementation. EHS improves patient safety and confidentiality and ensures operative, effective, well-timed, reasonable, and patient-centred care, all of which substantially impact healthcare quality. Blockchain technology has been used by the EHS system, which supports web-based accessibility and availability. The difficulties of exchanging medical data can now be overcome by consumers using an infrastructure based on cloud computing. A variety of cryptographic approaches have been employed to encrypt and safeguard the data. This review paper aims to highlight the role and impact of blockchain in EHR. The proposed research describes cryptography methods, their classifications, and the challenges associated with EHR to identify gaps and countermeasures

Impact of EHR Usability on Provider Efficiency and Patient Safety in Non-Hospital Settings

Healthcare organizations may reap benefits transitioning to electronic health records (EHRs), such as decreased healthcare costs and better care. However, severe unintended consequences from implementation and design of these systems have emerged. Poorly implemented EHR systems may endanger the integrity of clinical or administrative data. That, in turn, can lead to errors jeopardizing patient safety or quality of care. A literature review of 40 sources identified how EHR implementation and design can impact provider centric, patient centric, and outcomes. These categories provided the basis for a comprehensive EHR impact model that was evaluated in non-hospital settings through focus groups interviews

Business Process Redesign in the Perioperative Process: A Case Perspective for Digital Transformation

This case study investigates business process redesign within the perioperative process as a method to achieve digital transformation. Specific perioperative sub-processes are targeted for re-design and digitalization, which yield improvement. Based on a 184-month longitudinal study of a large 1,157 registered-bed academic medical center, the observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across perioperative sub-processes. This research identifies existing limitations, potential capabilities, and subsequent contextual understanding to minimize perioperative process complexity, target opportunity for improvement, and ultimately yield improved capabilities. Dynamic technological activities of analysis, evaluation, and synthesis applied to specific perioperative patient-centric data collected within integrated hospital information systems yield the organizational resource for process management and control. Conclusions include theoretical and practical implications as well as study limitations

The Promise of Health Information Technology: Ensuring that Florida's Children Benefit

Substantial policy interest in supporting the adoption of Health Information Technology (HIT) by the public and private sectors over the last 5 -- 7 years, was spurred in particular by the release of multiple Institute of Medicine reports documenting the widespread occurrence of medical errors and poor quality of care (Institute of Medicine, 1999 & 2001). However, efforts to focus on issues unique to children's health have been left out of many of initiatives. The purpose of this report is to identify strategies that can be taken by public and private entities to promote the use of HIT among providers who serve children in Florida