MEDICAL RECORD SUPPORT FOR EFFECTIVE DISCHARGE PLANNING

Little is known about the Information Technology artefacts which help inform decision-making to sup-port people returning home following a hospital stay. Content, delivery, timing and information about personal circumstances form integral components of person-centred discharge planning. From an Information Systems (IS) perspective, understanding barriers to information flow, artefacts in use and the context in which they are presented to health care professionals is the first step to explore how currently used IS support or fail to support the discharge process. This research-in-progress uses Roy’s Adaption Model and Adaptive Structuration Theory to explore to what extent patient infor-mation documented in the medical record supports and enables person-centred discharge planning. We aim specifically to understand how the medical record shapes discharge planning through clini-cian-to-clinician and clinician-to-patient information sharing to support a patient’s recovery journey when home. Findings suggest that the medical record is insufficient to support and enable person-centred discharge planning. We suggest how these limitations can be overcome to improve person-centred discharge planning to assist and facilitate patients’ transition home

Brokers as Catalysts for the E-Health Market

In this study we use the experiences from the service industry and explore pre-requisites of the e-health market which will need to achieve to stimulate both sides of the market (vendors, healthcare organizations, government, institutions, corporations and services organizations) to interact with each other and develop demand driven services and social innovations. The results presented in this paper may be of interest for decision makers, industries (e.g. software or technology designers), small and medium enterprises (SME) and entrepreneurs with an interest in becoming a part of the e-health market, and for consumers (e.g. healthcare personnel and patients) that are willing to influence the market through their choices. The outcomes of the study shown that the role of virtual brokers is essential to the further development of a sustainable e-health market globally because its role as catalyst for interaction between the two-sides of the markets, its effects on the reduction of competitive constrains, its effects on the accessibility to broader network of actors and its effects on the support of public-private exchanges of knowledge and experience

Providers' assessment of a novel interactive health information technology in a pediatric intensive care unit

Objective: To explore perceptions of critical care providers about a novel collaborative inpatient health information technology (HIT) in a pediatric intensive care unit (PICU) setting. Methods: This cross-sectional, concurrent mixed methods study was conducted in the PICU of a large midwestern children's hospital. The technology, the Large Customizable Interactive Monitor (LCIM), is a flat panel touch screen monitor that displays validated patient information from the electronic health record. It does not require a password to login and is available in each patient's room for viewing and interactive use by physicians, nurses, and families. Quantitative data were collected via self-administered, standardized surveys, and qualitative data via in-person, semistructured interviews between January and April 2015. Data were analyzed using descriptive statistics and inductive thematic analysis. Results: The qualitative analysis showed positive impacts of the LCIM on providers' workflow, team interactions, and interactions with families. Providers reported concerns regarding perceived patient information overload and associated anxiety and burden for families. Sixty percent of providers thought that LCIM was useful for their jobs at different levels, and almost 70% of providers reported that LCIM improved information sharing and communication with families. The average overall satisfaction score was 3.4 on a 0 to 6 scale, between "a moderate amount" and "pretty much." Discussion and Conclusion: This study provides new insight into collaborative HIT in the inpatient pediatric setting and demonstrates that using such technology has the potential to improve providers' experiences with families and just-in-time access to EHR information in a format more easily shared with families

Evaluating the impact of Inpatient Pain Management Interactive Systems

University of Minnesota Ph.D. dissertation. August 2019. Major: Health Informatics. Advisors: Genevieve Melton-Meaux, Michael Pitt. 1 computer file (PDF); xii, 86 pages.The management of patients’ pain is essential for improving the overall quality of patient care. Equally important, is the patient’s role in managing their pain and the health system’s role in creating the ideal environment that supports high quality patient-centered care. Accordingly, many hospitals have and are investing in patient engagement technology systems aimed in supporting patients in their pain management care process. Despite the decade-plus existence of pain interactive entertainment systems, which are designed to distract patients from pain during treatment, their role in the management of pain remains understudied. Some of these interactive systems, in addition to their entertainment features, also include other functions to deliver standardized patient education and support the integration of patient-reported pain assessments into the electronic health record (EHR). However, despite technological advances that support this integration, this functionality is rarely implemented and researchers have rarely studied the effects of adopting interactive pain management systems (IPMS) in the inpatient setting. The objectives of this body of research are to address this gap in knowledge by evaluating various aspects of IPMS. The study was conducted in four phases: 1) examining the current evidence around and the state of IPMS, 2) evaluating the effect of a novel IPMS at the University of Minnesota Masonic Children’s Hospital (UMMCH), 3) characterizing user experience and satisfaction with use of IPMS and 4) understanding the population that utilizes the inpatient IPMS for the management of pain. We conducted a systematic literature review across seven databases to understand the current state of IPMS in an inpatient setting and examine their clinical outcomes. Out of the reviewed full-text articles, 17 were eligible and included in the final qualitative synthesis. Overall, there were two main types of IPMS within the inpatient setting; stand- alone systems and integrated platform systems. Reports examined a variety of outcome measures, including changes in patient-reported pain levels, patient engagement, user satisfaction, changes in clinical workflow, and changes in documentation. In our second study, we conducted a mixed methods case study approach to describe the development of a IPMS at the UMMCH and to evaluate the impact of implementation on clinical workflow, patient use, and compliance with nursing documentation of their pain reassessments. We employed a retrospective analysis of 56,931 patient records covering pre- and post- implementation. Despite nursing pain reassessment documentation being relatively low, implementation of the system led to a statistically significant increase in the overall nurse documentation and resulted in patient access to nonpharmacologic strategies to eliminate pain. In our third study, benefits and challenges on the use of an inpatient IPMS were identified by parents and nurses. Overall, there was a cohesive agreement among users regarding the impact of the IPMS in engaging and empowering patients/families, increasing patient satisfaction, and creating a communication platform, with the most usefulness feature being “Support of Timely Pain Reassessments”. Thematic content analysis was conducted to analyze nurse responses and identify high level themes. Six themes emerged related to “Benefits” from using the system: Phone Reminders, EHR Automatic Documentation, Decision Support, Patient Empowerment, Sense of Connection and Non-Medication Resources. There were also 12 “Challenges”: Uncertainty of Patient Rating Scores, Training Needs, Distraction, Discourage Best Practice, Low Utilization, Low Utilization Due to Environmental Factors, System Design Limitations, Pain Scale Discrepancy, Low Utilization Due to Patient Factors, Patient/Family Dissatisfaction, Workflow and Duplicate Charting Requirement. The ability to identify user experience associated with the use of these systems, potentially assists in designing IPMS to maximize positive impact on clinical outcomes and care quality. Finally, by conducting a retrospective analysis of inpatient records, our fourth study demonstrated differences in the patients’ IPMS usage among different hospital units based on the care and medical service these units provide and an increased usage was associated with the time of medication administration. Overall, this research collectively demonstrated the benefits of IPMSs and showed the potential of these systems in improving the patient and provider experience and the quality of care. Evaluating the effects of these systems on clinical outcomes, patient satisfaction, hospital workflow, and barriers and facilitators associated with the use of these systems is an important component in developing meaningful health information technology (HIT) systems to engage patients and address pain

Conceptual model of mobile augmented reality for engaging hearing-impaired museum visitors

Mobile Augmented Reality (MAR) has matured significantly over the past decades since the birth of multimedia system. It has evolved from the conceptual idea of augmented reality experience to its actual practical applications in use on smartphones. Researchers in MAR have resolved to employ the concept of engagement in designing MAR applications to attract museum visitors’ interest and ensure a more effective learning environment. However, most of these MAR applications are tailored to normal hearing visitors while the hearing-impaired (HI) visitors are less supported. This makes HI visitors to go through unpalatable experiences and eventually become dissatisfied with their visit to the museum. Also, there is lack of studies on the conceptual model of MAR for engaging the HI museum visitors. Therefore, this study proposes a conceptual model of MAR for the HI museum engagement (MARHIME) and eventually enhances their engagement during their museum visits. In achieving the aim of this study, design science research methodology was adapted. This study has determined engagement elements through expert review which were used to design the conceptual model of MARHIME. In addition, an MAR prototype was developed based on the MARHIME conceptual model and its architecture. The MARHIME prototype includes three-dimensional models, video, text, and images to deliver salient information of important artefacts to HI museum visitors. Moreover, the MARHIME application may only function in the museum by scanning the museum environment because the HI can use MAR as a visual signal guide in order to catch missing aural signals during their visit to the museums. The study involved 73 HI museum visitors as participants in order to evaluate the MARHIME prototype on their engagement experience. From the results of the evaluation, it was found that the MARHIME prototype was able to engage the HI visitors during their visit to the museum. Therefore, this study has validated a conceptual model on MAR for engaging the HI museum visitors. This conceptual model of MARHIME can be used as guidelines for researchers in understanding the elements of MAR in engaging the HI museum visitors and for developers in assisting the process of designing and developing MAR application for the HI museum visitors. This study contributes to the engagement of HI people during their museum visits to ensure the inclusiveness of disabled people in the MAR design