Visual Analytics Dashboard Promises to Improve Hypertension Guideline Implementation

BACKGROUND: Primary care management of hypertension under new guidelines incorporates assessment of cardiovascular disease risk and commonly requires review of electronic health record (EHR) data. Visual analytics can streamline the review of complex data and may lessen the burden clinicians face using the EHR. This study sought to assess the utility of a visual analytics dashboard in addition to EHR in managing hypertension in a primary care setting. METHODS: Primary care physicians within an urban, academic internal medicine clinic were tasked with performing two simulated patient encounters for HTN management: the first using standard EHR, and the second using EHR paired with a visual dashboard. The dashboard included graphical blood pressure trends with guideline-directed targets, calculated ASCVD risk score, and relevant medications. Guideline-appropriate antihypertensive prescribing, correct target blood pressure goal, and total encounter time were assessed. RESULTS: We evaluated 70 case simulations. Use of the dashboard with the EHR compared to use of the EHR alone was associated with greater adherence to prescribing guidelines (95% vs. 62%, p\u3c0.001) and more correct identification of BP target (95% vs. 57%, p\u3c0.01). Total encounter time fell an average of 121 seconds (95% CI 69 - 157 seconds, p\u3c0.001) in encounters that used the dashboard combined with the EHR. CONCLUSIONS: The integration of a hypertension-specific visual analytics dashboard with EHR demonstrates the potential to reduce time and improve hypertension guideline implementation. Further widespread testing in clinical practice is warranted

Two Essays on Analytical Capabilities: Antecedents and Consequences

Although organizations are rapidly embracing business analytics (BA) to enhance organizational performance, only a small proportion have managed to build analytical capabilities. While BA continues to draw attention from academics and practitioners, theoretical understanding of antecedents and consequences of analytical capabilities remain limited and lack a systematic view. In order to address the research gap, the two essays investigate: (a) the impact of organization’s core information processing mechanisms and its impact on analytical capabilities, (b) the sequential approach to integration of IT-enabled business processes and its impact on analytical capabilities, and (c) network position and its impact on analytical capabilities. Drawing upon the Information Processing Theory (IPT), the first essay investigates the relationship between organization’s core information processing mechanisms–i.e., electronic health record (EHRs), clinical information standards (CIS), and collaborative information exchange (CIE)–and its impact on analytical capabilities. We use data from two sources (HIMSS Analytics 2013 and AHA IT Survey 2013) to test the theorized relationships in the healthcare context empirically. Using the competitive progression theory, the second essay investigates whether organizations sequential approach to the integration of IT-enabled business processes is associated with increased analytical capabilities. We use data from three sources (HIMSS Analytics 2013, AHA IT Survey 2013, and CMS 2014) to test if sequential integration of EHRs –i.e., reflecting the unique organizational path of integration–has a significant impact on hospital’s analytical capability. Together the two essays advance our understanding of the factors that underlie enabling of firm’s analytical capabilities. We discuss in detail the theoretical and practical implications of the findings and the opportunities for future research

The Second International Conference on Health Information Technology Advancement

TABLE OF CONTENTS I. Message from the Conference Co-Chairs B. Han and S. Falan …………………………....….……………. 5 II. Message from the Transactions Editor H. Lee …...………..………….......………….……….………….... 7 III. Referred Papers A. Emerging Health Information Technology and Applications The Role of Mobile Technology in Enhancing the Use of Personal Health Records Mohamed Abouzahra and Joseph Tan………………….……………. 9 Mobile Health Information Technology and Patient Care: Methods, Themes, and Research Gaps Bahae Samhan, Majid Dadgar, and K. D. Joshi…………..…. 18 A Balanced Perspective to Perioperative Process Management Jim Ryan, Barbara Doster, Sandra Daily, and Carmen Lewis…..….…………… 30 The Impact of Big Data on the Healthcare Information Systems Kuo Lane Chen and Huei Lee………….…………… 43 B. Health Care Communication, Literacy, and Patient Care Quality Digital Illness Narratives: A New Form of Health Communication Jofen Han and Jo Wiley…..….……..…. 47 Relationships, Caring, and Near Misses: Michael’s Story Sharie Falan and Bernard Han……………….…..…. 53 What is Your Informatics Skills Level? -- The Reliability of an Informatics Competency Measurement Tool Xiaomeng Sun and Sharie Falan.….….….….….….…. 61 C. Health Information Standardization and Interoperability Standardization Needs for Effective Interoperability Marilyn Skrocki…………………….…….………….… 76 Data Interoperability and Information Security in Healthcare Reid Berryman, Nathan Yost, Nicholas Dunn, and Christopher Edwards.…. 84 Michigan Health Information Network (MiHIN) Shared Services vs. the HIE Shared Services in Other States Devon O’Toole, Sean O’Toole, and Logan Steely…..……….…… 94 D. Health information Security and Regulation A Threat Table Based Approach to Telemedicine Security John C. Pendergrass, Karen Heart, C. Ranganathan, and V.N. Venkatakrishnan …. 104 Managing Government Regulatory Requirements for Security and Privacy Using Existing Standard Models Gregory Schymik and Dan Shoemaker…….…….….….… 112 Challenges of Mobile Healthcare Application Security Alan Rea………………………….……………. 118 E. Healthcare Management and Administration Analytical Methods for Planning and Scheduling Daily Work in Inpatient Care Settings: Opportunities for Research and Practice Laila Cure….….……………..….….….….… 121 Predictive Modeling in Post-reform Marketplace Wu-Chyuan Gau, Andrew France, Maria E. Moutinho, Carl D. Smith, and Morgan C. Wang…………...…. 131 A Study on Generic Prescription Substitution Policy as a Cost Containment Approach for Michigan’s Medicaid System Khandaker Nayeemul Islam…….…...……...………………….… 140 F. Health Information Technology Quality Assessment and Medical Service Delivery Theoretical, Methodological and Practical Challenges in Designing Formative Evaluations of Personal eHealth Tools Michael S. Dohan and Joseph Tan……………….……. 150 The Principles of Good Health Care in the U.S. in the 2010s Andrew Targowski…………………….……. 161 Health Information Technology in American Medicine: A Historical Perspective Kenneth A. Fisher………………….……. 171 G. Health Information Technology and Medical Practice Monitoring and Assisting Maternity-Infant Care in Rural Areas (MAMICare) Juan C. Lavariega, Gustavo Córdova, Lorena G Gómez, Alfonso Avila….… 175 An Empirical Study of Home Healthcare Robots Adoption Using the UTUAT Model Ahmad Alaiad, Lina Zhou, and Gunes Koru.…………………….….………. 185 HDQM2: Healthcare Data Quality Maturity Model Javier Mauricio Pinto-Valverde, Miguel Ángel Pérez-Guardado, Lorena Gomez-Martinez, Martha Corrales-Estrada, and Juan Carlos Lavariega-Jarquín.… 199 IV. A List of Reviewers …………………………..…….………………………208 V. WMU – IT Forum 2014 Call for Papers …..…….…………………20

Development and assessment of evidence-based strategies towards increased feasibility and transparency of investigator-initiated clinical trials in Switzerland

This work addresses the obligation to minimize research waste by identifying barriers and needs for support in important processes of clinical research and by proposing efficient strategies to improve the quality of research practice. Major sources of waste in clinical research have been identified by the “Increasing Value, Reducing Waste” series in The Lancet in 2014. Two considerations in this series address the problem of inefficient trial management and insufficient research transparency. Collected evidence suggests that inefficient management and monitoring of the procedural conduct of trials are a major source of waste even in well-designed studies addressing important questions. The absence of a continuous oversight of established trial processes endanger completion of trials in a set timeframe or even cause premature discontinuation. Increasing feasibility of clinical trials by providing an evidence-based strategy to effectively support the conduct of clinical trials at the University Hospital of Basel that has the potential to be transferred to the whole academic network for clinical research in Switzerland was aspired in this thesis. Along with feasibility, it is important that information of a trial including results is publicly available. In Switzerland, prospective registration of a clinical trial in a primary trial registry has been made mandatory by law in 2014 (Art 56 Human Research Act). We analyzed research transparency in terms of trial registration and results publication in a local setting in Switzerland to assess the successful implementation and enforcement of national efforts and identify potential barriers. In a first step, we systematically reviewed existing evidence on effective monitoring strategies both in the medical literature and across international clinical research stakeholder groups. Monitoring strategies varied in their methodological approach but the effectiveness of risk-based and triggered approaches could be shown with moderate certainty. However, we did not find evidence on the effect of these methods on the overall trial conduct. Based on these findings, we then engaged local, national and international stakeholder representatives in the creation of a comprehensive risk-tailored approach integrating monitoring in the broader context of trial management. We systematically reviewed information on risk indicators commonly used to guide monitoring in the academic setting and in industry and identified risk elements extended to the overall management of a clinical trial. In order to continuously visualize the status of identified risk elements throughout the study conduct, we initiated the user-centered development of a supporting study dashboard. The final risk-tailored approach consisted of the following components: A study-specific risk assessment prior to study start, selection and development of data based pathways addressing the identified risks, and the continuous visualization of the status of risk elements in a study dashboard. The generic content of the dashboard provides continuous information and support for risk indicators applicable to almost all clinical trials (Data quality, Recruitment, Retention, and Safety management) and the optional content is based on further study-specific items identified during the risk assessment (e.g. Follow-up visits, Re-consent process, Sampling management, Imaging quality). User-testing of the risk assessment and study dashboards developed on the basis of the assessment revealed that the continuous oversight of most critical elements and support of managing these elements efficiently supports the work routine of principle investigators, trial managers and trial monitors. In a second project of this thesis, we assessed current trial registration and publication for clinical intervention studies approved by the Ethics Committee North and Central Switzerland (EKNZ) in the last five years. Registration of all clinical trials would provide an overview of what research is being conducted at present and registries constitute an ideal platform for the publication and dissemination of research results.. Identifying factors influencing registration and potential barriers provides a basis for further initiatives to increase trial registration. Prospective trial registration has increased over the last five years and trials with higher risk category, multicenter trials and trials taking advantage of Clinical Trials Unit services were associated with higher registration rates. Although prospective trial registration prevalence has improved within the last five years within the EKNZ approved studies, a strong need for support in the registration process was identified in our qualitative evaluation. The impact of this work - and whether it eventually increases feasibility and transparency in clinical research critically depends on its implementation, evaluation, and refinement. Sharing current knowledge on effective monitoring strategies with trialists and monitors to choose evidence-based strategies for their trials constitutes a major support for investigator-initiated trials in the academic environment. The advancement of a risk-based trial monitoring approach into a comprehensive risk-tailored approach supporting the overall conduct of a trial and considering trial monitoring as an integrative part of trial management has the potential to efficiently optimize study processes. While an uptake of the study specific risk assessment and the use of a study dashboard as a standard process would be aspired for all RCTs in the future, improving the timeline and resources needed for the development of a study specific dashboard will be important to advance the generation of affordable and efficient dashboards for investigator-initiated trials. Sharing evidence on the registration behavior and perceived barriers by researchers in the local setting of the EKNZ helps to understand underlying processes and test measures for improvement. Supporting researchers in the process of trial registration and educating research institutes and investigators about the need and advantages of trial registration, has the potential to facilitate the implementation of automated processes and SOPs ensuring the registration of all clinical trials. Establishing trial registries as a primary platform for sharing research results should be aspired in the future

A flexible, longitudinal and surrogate consent model: Consent of Infants for Neonatal Secondary-use research (CoINS) Model

Documenting healthcare, along with technology enabling capture of streaming patient telemetry, can deliver large datasets offering opportunities to discover new insights primarily identified through retrospective secondary use research. Research involving health data requires consent of the subject patient or someone with the power to speak on that patient???s behalf. Flexible consent models that capture consent preferences while allowing updates as preferences change are needed. This research proposes and demonstrates one solution in a case study collecting surrogate consent from parents for the physiological data of infant inpatients in the Neonatal Intensive Care Unit (NICU) and attaching this consent as a wrapper controlling access to their data. 145 parents were approached and 134 provided consent: with 78 percent of infants consented during their first week of life. This research supports the contention that using a flexible consent approach enhances willingness to consent use of infant???s health data for secondary research purposes