How the presentation of patient information and decision-support advisories influences opioid prescribing behavior: A simulation study

ObjectiveThe United States faces an opioid crisis. Integrating prescription drug monitoring programs into electronic health records offers promise to improve opioid prescribing practices. This study aimed to evaluate 2 different user interface designs for prescription drug monitoring program and electronic health record integration.Materials and MethodsTwenty-four resident physicians participated in a randomized controlled experiment using 4 simulated patient cases. In the conventional condition, prescription opioid histories were presented in tabular format, and computerized clinical decision support (CDS) was provided via interruptive modal dialogs (ie, pop-ups). The alternative condition featured a graphical opioid history, a cue to visit that history, and noninterruptive CDS. Two attending pain specialists judged prescription appropriateness.ResultsParticipants in the alternative condition wrote more appropriate prescriptions. When asked after the experiment, most participants stated that they preferred the alternative design to the conventional design.ConclusionsHow patient information and CDS are presented appears to have a significant influence on opioid prescribing behavior

Repairing Innovation: A Study of Integrating AI in Clinical Care

Over the past two years, a multi-disciplinary team of clinicians and technologists associated with Duke University and Duke Health system have developed and implemented Sepsis Watch, a sociotechnical system combining an artificial intelligence (AI) deep learning model with new hospital protocols to raise the quality of sepsis treatment. Sepsis is a widespread and deadly condition that can develop from any infection and is one of the most common causes of death in hospitals. And while sepsis is treatable, it is notoriously difficult to diagnose consistently. This makes sepsis a prime candidate for AI-based interventions, where new approaches to patient data might raise levels of detection, treatment, and, ultimately, patient outcomes in the form of fewer deaths.As an application of AI, the deep learning model tends to eclipse the other parts of the system; in practice, Sepsis Watch is constituted by a complex combination of human labor and expertise, as well as technical and institutional infrastructures. This report brings into focus the critical role of human labor and organizational context in developing an effective clinical intervention by framing Sepsis Watch as a complex sociotechnical system, not just a machine learning model

Shadow Standards and the Logic of Costs: Care, Stewardship, and Data in U.S. Community Health

This dissertation examines the delegation of responsibility for providing health care to particular categories of marginalized populations in the United States in the absence of a uniform and universal health care system. It explores how the U.S. federal government governs patient populations at a distance by mandating that healthcare providers collect, produce, and report on patient data. Drawing from eighteen months of ethnographic research in Massachusetts clinics for the homeless and the frail elderly between 2014-2015, I argue that when marginalized patients are unable to satisfy the neoliberal ideal of self-governance to maintain their health in cost-effective ways, providers are activated to bring them into compliance. Through the lens of political economic, science and technology studies, and critical medical anthropologies, I identified how reimbursement models and government funding requirements redesigned under the 2010 Affordable Care Act obligate health care providers to reframe the care they provide. Providers cultivate what I term the “logic of costs,” a budgetary lens for making care decisions that frames management of costs as essential to care. Data creation and reporting practices require providers to adopt a logic of costs, as such data informs whether their clinics will be deemed effective and the clinics’ funding reauthorized. I trace the incongruities between actual care practices and the metrics that clinics end up recording and submitting to represent their work and their patients. I argue that this work is made possible through the creation of “shadow standards,” unofficial, undocumented, and yet routinized healthcare practices that make the creation and reporting of health data possible, even when providers do not have the resources to comply

The Future of Service Post-COVID-19 Pandemic, Volume 1

This open access book is geared towards providing insights and stimulating new thinking about the changing nature of services, service work and workers, and service experiences during and after the COVID-19 pandemic in 2020, particularly focusing on digital service technology. This book serves as a useful resource for business practitioners and academics in the areas of service and human resource management. Each chapter deals with specific current issues within these industries due to COVID-19 and issues that will come up post-pandemic. As COVID-19 is expected introduce novel methods to the service sector, such as untact service, telecommuting, alternative work arrangements, job crafting, and new work skills, digital technology is becoming more important than ever before. This books provides a range of examples and cases to elaborate on the effective application of digital service technology in order for businesses to stay relevant in the current climate

Emerging Insights on Building Infrastructure for Data-Driven Transparency and Accountability of Organizations

Diverse domains including education, healthcare, and business are attempting to harness IT and data science to govern individual and organizational performance. Largely centered on performance measurement, data-driven accountability tools are used to engineer work processes according to best practices and transfer policy to practice through tying quantitative outcomes to consequential valuation schemes. In this early work, we present preliminary insights from a multi-sited ethnography of ongoing development of infrastructure for data science being developed for purposes of organizational accountability in the healthcare. The aim is to describe key concerns in the design of ‘infrastructure for accountability’ (consisting of the array IT, organizations, organizational relationships, standards, and roles being developed to undergird performance measurement). Some initial considerations for design of infrastructure for accountability include dual functions of the data, communication hierarchy, emergent seams, and bridging installed bases and communities of practice. This research has implications for researchers, designers, and managers of infrastructure for accountability, as well contributing ethnographic empirical insights into social and organizational implications of creating the data-driven world.ye

Occasioning Dialogic Spaces of Innovation: The pan-Canadian EHR, Infoway and the Re-Scripting of Healthcare

The Canadian public healthcare system appears to currently be under considerable strain. Escalating costs, dwindling budgets and growing patient dissatisfaction are just a few of the systemic pressures that have called into question our current ways of delivering healthcare. As a consequence, there is a growing recognition that renewal is needed, and that this renewal, to be successful, should meet the needs of a wide array of stakeholders, hence calling for unprecedented levels of collaboration among increasingly fragmented interests. In order to bring about this renewal, the federal government seems to be intent on implementing a pan-Canadian electronic health record (EHR) system. To that end, in 2001, Canada Health Infoway was born out of a novel collaboration between federal and jurisdictional health ministries with the specific mandate to accelerate the implementation of EHRs across Canada. In this thesis, I use material-semiotic and dialogic approaches to gain a more nuanced understanding of how the pan-Canadian EHR system is unfolding and in what ways Infoway is trying to accelerate that unfolding. I conclude by suggesting that a more dialogic approach to innovating, in which the innovator focuses on finding various ways to occasion dialogic spaces, may better foster the creation of new meanings of the innovation and therefore result in a more, and not less, harmonious change process. Furthermore, through these dialogic spaces, it is not just multiple meanings of the innovation that are being occasioned, but the innovation itself seems to become more meaningful

The Future of Service Post-COVID-19 Pandemic, Volume 1

This open access book is geared towards providing insights and stimulating new thinking about the changing nature of services, service work and workers, and service experiences during and after the COVID-19 pandemic in 2020, particularly focusing on digital service technology. This book serves as a useful resource for business practitioners and academics in the areas of service and human resource management. Each chapter deals with specific current issues within these industries due to COVID-19 and issues that will come up post-pandemic. As COVID-19 is expected introduce novel methods to the service sector, such as untact service, telecommuting, alternative work arrangements, job crafting, and new work skills, digital technology is becoming more important than ever before. This books provides a range of examples and cases to elaborate on the effective application of digital service technology in order for businesses to stay relevant in the current climate

Designing for Lived Health: Engaging the Sociotechnical Complexity of Care Work

As healthcare is increasingly shaped by everyday interaction with data and technologies, there is a widespread interest in creating information systems that help people actively participate in managing their own health and wellness. To date, personal health technologies are largely designed as large-scale “patient-centered” systems, grounded in a biomedical model of care and clinical processes and/or commercial “self-care” technologies, that seek to facilitate individual behavior change through activities like fitness tracking. Through investigating the lived experience of chronic illness—multiple, messy, and often the site of uncomfortable dependencies—my thesis empirically and theoretically engages the limitations of such popular design narratives to address sociotechnical complexities in personal health management. My findings, drawn from people’s care practices across three distinct field sites, argue for a need to contend with lived health: the ways in which everyday health and wellness activities are connected to wider ecologies of care that include the emotional labor of family and friends, entanglements of data, machineries and bodies, localized networks of resources and expertise, and contested forms of information work. My thesis contributes to the literature of Information and Computer Science in the fields of Human-Computer Interaction and Computer-Supported Cooperative Work by offering an alternative analytical lens for designing health systems that support a wider range of people’s social and emotional needs.PHDInformationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/146030/1/eskaziu_1.pd

An Investigation of the Factors that Contribute to the Perceived Likelihood of Compliance with the HIPAA Security Rule among Healthcare Covered Entities and Business Associates

The Health Insurance Portability and Accountability Act (HIPAA) Security Rule (SR) mandate provides a national standard for the safeguard of electronically protected health information (ePHI). SR compliance enforcement efforts started in 2005; however, U.S.-based covered entities and business associates (CEs & BAs) remain challenged to comply with the HIPAA SR regulatory strategy. Although there is a significant volume of academic research on HIPAA compliance, research specific to the SR is sparse. This study addressed the research gap by designing a unique conceptual model that assessed factors affecting CEs & BAs compliance (or non-compliance) with the SR regulatory strategy. The primary goal of this research study was to develop and empirically measure how motive, characteristics and capacity, regulator respect, and deterrence factors impacted the perceived likelihood of compliance with HIPAA SR in healthcare CEs & BAs operating in the United States. Multiple linear regression determined whether motive, characteristics and capacity, regulator respect, or deterrence factors better predicted the perceived likelihood of compliance with HIPAA SR, rather than any single factor alone. Only characteristics and capacity were a statistically significant predictor of the perceived likelihood of compliance. Motive and characteristics and capacity were significantly and positively correlated with the perceived likelihood of compliance with HIPAA SR. A negative correlation existed between the perceived likelihood of compliance with HIPAA SR and deterrence factors. There was no correlation between a perceived likelihood of compliance with HIPAA SR regulator respect. This research contributes toward filling the previous knowledge gap and providing insight into the factors and challenges CEs & BAs face in meeting compliance mandates