MAKING PEOPLE AWARE OF DEVIATIONS FROM STANDARDS IN HEALTH CARE

In this paper we consider the role of standards as a means for interoperability among members of different communities. If we consider, in particular, the healthcare domain, there is an increasing number of efforts to develop explicit and formal representations of medical concepts so as to provide a common infrastructure for the reuse of clinical information and for the integration and the sharing of medical knowledge across the world. A critical issue raises when local customizations of standards are used as standards. If this occurs, standards are no more able to guarantee their supportive function to interoperability. To overcome this problem we propose a solution aiming at making members of different facilities aware of the changes occurred locally in a standard. At architectural level, we propose to build a layer that acts upon the interface of the application by which the articulation of activities across organizational boundaries is mediated (e.g., an handing over between different healthcare facilities). At application level, we provide practitioners with a common visual notation allowing them enrich the artifacts that mediate inter-articulation, by means of a reference to a standard, e.g. a schema of intervention. We claim that this increased awareness can support different people in aligning practices with standards and making standards effective means for coordination and interoperability. Furthermore, we report a case focusing on such a layer and visual notation by which to enrich the interface of the information system that mediates the handingover between an Emergency Service and a hospital emergency department

Infection prevention as "a show": a qualitative study of nurses' infection prevention behaviours

Background: Control of infection and prevention of healthcare associated infections is an ongoing issue worldwide. Yet despite initiatives and strategies to reduce the burden that these infections cause, healthcare workers' practice is still reported as suboptimal and these infections persist. Much of the research to date has primarily focused on predicting infection prevention behaviours and factors associated with guideline compliance. While this has given valuable insight, an investigation aiming to understand and explain behaviours that occur in everyday practice from the perspective of the actors themselves may hold the key to the challenges of effecting behaviour change. This study questioned "How can nurses' infection prevention behaviour be explained?" This paper presents one of three identified themes 'Rationalising dirt-related behaviour'. Design: This interpretative qualitative study uses vignettes, developed from nurses' accounts of practice, to explore nurses' reported infection prevention behaviours. Participants: Registered nurses working in an acute hospital setting and had been qualified for over a year. They were recruited while studying part-time at a London University. Methods: Twenty semi-structured interviews were undertaken using a topic guide and vignettes. Interviews were transcribed verbatim and analysed using the framework method. Results: The findings demonstrate that participants were keen to give a good impression and present themselves as knowledgeable practitioners, although it was evident that they did not always follow procedure and policy. They rationalised their own behaviour and logically justified any deviations from policy. Deviations in others were criticised as irrational and explained as superficial and part of a 'show' or display. However, participants also gave a presentation of themselves: a show or display that was influenced by the desire to protect self and satisfy patient scrutiny. Conclusions: This study contributes to the identification and explanation of nurses' infection prevention behaviours which are considered inappropriate or harmful. Behaviour is multifaceted and complex, stemming from a response to factors that are outside a purely 'scientific' understanding of infection and not simply understood as a deficit in knowledge. This calls for educational interventions that consider beliefs, values and social understanding of dirt and infection. © 2013 Elsevier Ltd

Medical data processing and analysis for remote health and activities monitoring

Recent developments in sensor technology, wearable computing, Internet of Things (IoT), and wireless communication have given rise to research in ubiquitous healthcare and remote monitoring of human\u2019s health and activities. Health monitoring systems involve processing and analysis of data retrieved from smartphones, smart watches, smart bracelets, as well as various sensors and wearable devices. Such systems enable continuous monitoring of patients psychological and health conditions by sensing and transmitting measurements such as heart rate, electrocardiogram, body temperature, respiratory rate, chest sounds, or blood pressure. Pervasive healthcare, as a relevant application domain in this context, aims at revolutionizing the delivery of medical services through a medical assistive environment and facilitates the independent living of patients. In this chapter, we discuss (1) data collection, fusion, ownership and privacy issues; (2) models, technologies and solutions for medical data processing and analysis; (3) big medical data analytics for remote health monitoring; (4) research challenges and opportunities in medical data analytics; (5) examples of case studies and practical solutions

Does the Doctor Need a Boss?

The traditional model of medical delivery, in which the doctor is trained, respected, and compensated as an independent craftsman, is anachronistic. When a patient has multiple ailments, there is no longer a simple doctor-patient or doctor-patient-specialist relationship. Instead, there are multiple specialists who have an impact on the patient, each with a set of interdependencies and difficult coordination issues that increase exponentially with the number of ailments involved. Patients with multiple diagnoses require someone who can organize the efforts of multiple medical professionals. It is not unreasonable to imagine that delivering health care effectively, particularly for complex patients, could require a corporate model of organization. At least two forces stand in the way of robust competition from corporate health care providers. First is the regime of third-party fee-for-service payment, which is heavily entrenched by Medicare, Medicaid, and the regulatory and tax distortions that tilt private health insurance in the same direction. Consumers should control the money that purchases their health insurance, and should be free to choose their insurer and health care providers. Second, state licensing regulations make it difficult for corporations to design optimal work flows for health care delivery. Under institutional licensing, regulators would instead evaluate how well a corporation treats its patients, not the credentials of the corporation's employees. Alternatively, states could recognize clinician licenses issued by other states. That would let corporations operate in multiple states under a single set of rules and put pressure on states to eliminate unnecessarily restrictive regulations

The Relationship Between Health Beliefs and Adherence to Treatment of Russian Immigrants with Hypertension

Introduction: Hypertension (HTN) has been identified as a common health problem in every ethnic group in the USA. Due to the silent nature of the HTN, some cultures may not perceive this condition as being serious or potentially fatal. Objective: The purpose of this study was to investigate the health beliefs of Russian-speaking immigrants with hypertension and their adherence to the prescribed treatment. Design: The study was a non-experimental exploratory survey and interview. Convenience sampling was used. The Health Belief Model (HBM) provided the theoretical framework. Sample: A total of 62 subjects (27% male and 73% female, ages from 51 to 86) completed the questionnaire that covered health beliefs and self-report on adherence to treatment. Results: This study indicated a correlation between embarrassment, inconvenience, and compliance with fitness recommendations. Financial burden correlated with adherence to dietary modifications. A strong negative correlation was found between perceived severity of complications and number of missed medications. Patient\u27s awareness about existence of complications of hypertension had a positive correlation with change in adherence to treatment. Educational level had no correlation with adherence. Conclusion: Health education based on these findings will facilitate the reduction of the rate of complications in the targeted population

Disclosing Deviations: Using Guidelines to Nudge and Empower Physician-Patient Decision Making

Americans fail to receive recommended care roughly half the time, reflecting poor decision making that threatens their health. This Article offers an innovative solution: require physicians to disclose clinical practice guideline recommendations to patients during informed consent. Behavioral economics suggest that insisting physicians and patients discuss guidelines, before deviating from them, could be surprisingly effective at nudging more rational care choices. At the same time, such disclosure should also educate and empower patients, serving autonomy. Previous scholarship on unwarranted variances in care has focused primarily on malpractice reforms, largely ignoring the role of cognitive bias and the importance of patients receiving empirically based, consensus recommendations. This Article provides important new analysis of the connection between cognitive bias in physician decision making and practice guidelines. It offers key insights on aligning informed consent with patient autonomy and begins an important dialogue on elevating the salience of guidelines, thereby improving physician-patient decision making practices