Organization's quality maturity as a vehicle for EHR success

In health care industry, EHR has been advocated to improve care quality. The journey toward the development and adaptation of EHR should be holistic and integrate all the EHR's building blocks-health record management, business process improvement (BPI), collaboration and innovation, change management, user governance, etc.-that are intertwined together as like the links of a chain to improve quality of health care services. These cornerstones that shares common features with quality principles will pave the way for implementing EHR. To go along with quality features and take advantage of quality principles namely "quality maturity" builds a solid foundation for adaptation of EHR. Therefore, the recent theories of EHR success go far beyond technical rationales and focus on organizational and managerial factors in quality improvement. The milestone of quality concept in information system success is revealed in Delone and Mclean's model which launches system quality, information quality, service quality, as distinct elements of the IS success. EHR is a means to an end -to improve quality within enterprises- based on quality approaches. In this regards, more research should be conducted to investigate the relationship between of organization's quality maturity and EHR development success. © Springer Science+Business Media, LLC 2010

Transactions of the First International Conference on Health Information Technology Advancement vol. 1, no. 1

Full proceedings of The First International Conference on Health Information Technology Advancement held at Western Michigan University in Kalamazoo, Michigan on October 28, 2011. Conference Co-Chairs: Dr. Bernard Han, Director of the Center for HIT Advancement (CHITA) at Western Michigan University Dr. Sharie Falan, Associate Director of the Center for HIT Advancement (CHITA) at Western Michigan University Transactions Editor: Dr. Huei Lee, Professor in the Department of Computer Information Systems at Eastern Michigan Universit

Healthcare leaders under the age of 40: successful strategies and practices for leading healthcare organizations

As millennials and young adults under the age of 40 become the growing majority, it is critical to understand their leadership profile, the workplace challenges they face, and their strategies for overcoming obstacles as young leaders. Specifically, in healthcare, the rapidly changing industry presents internal and external environmental challenges that must be handled in the most professional and proficient manner to be an effective leader. As such, the purpose of this study is to gather best strategies and practices that healthcare leaders under the age of 40 can adopt for their respective organizations. There are 4 research questions that address the research study’s purpose: (a) strategies and practices employed by healthcare leaders under 40, (b) challenges faced by healthcare leaders under 40, (c) definition and measurement of leadership success and organizational performance, and (d) recommendations for young aspiring leaders. 15 healthcare leaders under the age of 40 participated in the research study and responded to 12 questions in a semi-structured interview format. The results of the phenomenological qualitative study yielded 62 themes. In particular, the following emerged as top themes with regard to strategies and practices: servant leadership, authentic leadership, transformational leadership, emotional intelligence. Challenges faced by healthcare leaders included regulatory changes, healthcare reform, competing priorities, managing financial and human capital, and managing change. In terms of managing resistance to change, a four-part framework was developed through the following themes: educate people on the change, engage people in the process, listen and empathize, build a guiding coalition. As for obstacles experienced by young leaders, themes included proving credibility, perceptions of youth, lack of experience or knowledge. 60% stated that their definition of leadership success would be based on team development and success, followed by organizational success, personal achievement, and reduced staff turnover. A high performing organization focused on quality, engaging the workforce, patient experience, cost savings, financial growth and stability, and community outreach. To measure and track organizational performance, key performance indicators, dashboards, and balance scorecards were mentioned. The research study wrapped up with advice for young aspiring leaders with emotional intelligence emerging as a top theme

Academic Health Science Centers and Health Disparities: A Qualitative Review of the Intervening Role of the Electronic Health Record and Social Determinants of Health

Literature on the magnitude of negative health outcomes from health disparities is voluminous. Defined as the health effects of racism, environmental injustice, forms of discrimination, biases in science, and sociological or socioeconomic predictors across populations, health disparities are part of an ongoing and complicated national problem that health equity programs are specifically designed to address. Academic Health Science Centers (AHC) institutions are a complex and unique educational-healthcare ecosystem that often serves as a safety net for patients in vulnerable and lower-income communities. These institutions are often viewed as one of the most uniquely positioned entities in the U.S. with an abundance of resources and networks to advance health equity as a high-impact goal and strategic imperative. Relatively little progress, however, has been made to better understand the potentially transformative nature of how digital health technologies (DHT)—such as mobile health apps, electronic health record (EHR) and electronic medical record (EMR) systems, smart ‘wearable’ devices, artificial intelligence, and machine learning—may be optimized to better capture and analyze social determinants of health (SDH) data elements in order to inform strategies to address health disparities. Even less has been explored about the challenging implementation of electronic SDH screening and data capture processes within AHCs and how they are used to better inform decisions for patient and community care. This research examines how AHC institutions, as complex education-healthcare bureaucracies, have prioritized this specific challenge amongst many other competing incentives and agendas in order to ultimately develop better evidence-based strategies to advance health equity. While there are clear moral, ethical, and clinical motives for improving health outcomes for vulnerable populations, when an AHC demonstrates that electronically screening and capturing SDH can improve the ability to understand the “upstream” factors impacting their patients\u27 health outcomes, this can inform and influence policy-level choices in government legislation directed at community-level factors. A qualitative thematic analysis of interview data from AHC administrators and leadership illustrates how AHCs have mobilized their EHR as a featured component of their healthcare delivery system to address health disparities, exposing other related, multifactorial dimensions of the Institution and region. Key findings indicated that: electronic SDH screening and updating workflow processes within an AHC’s clinical enterprise is a significant venture with multiple risks and the potential of failure. Universal adoption and awareness of SDH screening is hampered by notions of hesitancy, skepticism, and doubt as to an AHC’s ability to meaningfully extract and use the data for decision-support systems. Additional investment in resources and incentive structures for capturing SDH are needed for continued monitoring of patient health inequalities and community social factors. Data from this and future replicated studies can be used to inform AHC and government decisions around health and social protection, planning, and policy

Өңірлік даму магистрі дәрежесін алу үшін магистрлік жоба

Зерттеудің мақсаты Маңғыстау облысы медициналық ұйымдарын цифрландырудың мәселелерін анықтау және оларды жетілдіру бойынша практикалық ұсыныстар әзірлеу

Өңірлік даму магистрі дәрежесін алу үшін магистрлік жоба

Зерттеудің мақсаты Маңғыстау облысы медициналық ұйымдарын цифрландырудың мәселелерін анықтау және оларды жетілдіру бойынша практикалық ұсыныстар әзірлеу

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Implicit Knowledge Transfer Use in Virtual Healthcare Information Systems Project Teams and Its Association With Successful Project Outcomes

This dissertation focuses on implicit knowledge transfer in virtual information systems project teams in the healthcare industry and the association of such knowledge transfer with successful projects. The use of virtual teams is expected to continue to increase, particularly because of the passage of the HITECH Act of 2009, calling for the computerization of medical records in the United States. Although the healthcare industry has had experience with virtual teams and the use of those teams is expected to increase, there has been little research done on how implicit knowledge transfer is linked to successful projects. A successful IT project is one that completes on time, on budget, meets requirements and user specifications, and satisfies stakeholders. This study identified and evaluated implicit knowledge transfer techniques, determining which forms of knowledge transfer were most often associated with successful projects. Four techniques were studied: communities of practice (CoP), after action reviews (AAR), mentoring and storytelling. Of these techniques, CoP and storytelling were most often associated with project success in four of the five success measures (ie. on time, meets requirements and user specifications, satisfies stakeholders). Additionally, the study evaluated when implicit knowledge transfer techniques were used (ie. “initiate”, “plan”, “execute”, “control”, “close” project phases) and project participant types (ie. team members, team leads, project managers and vendors). The study is the first to examine all these project dimensions (ie. project success, project type, project phase, and project participant types) and consider the interrelationships among these dimensions, as well as project success

An Exploration in Accountable Care Organization Structure, Contingency and Performance, 2015-2017

The Patient Protection and Affordable Care Act of 2010 enacted one of the most significant reforms seen in the United States healthcare landscape. The Center for Medicare and Medicaid (CMS) led transformation efforts in regulatory reform and coverage expansion across the U.S. population. Since 2010, care delivery systems have been shifting from episodic, decentralized and fee-for-service models to value-based population health models, like accountable care organizations (ACO). ACOs have been specifically primed for local response to improve the health of their communities. ACO research has traditionally focused on performance measures like mortality, readmissions, quality outcomes and savings. ACO organizational characteristics analyzed in the literature have focused on provider composition, health information technology, leadership structures and provider access. According to CMS, readmissions account for one of the greatest contributors in healthcare spend, and studies by The Commonwealth Fund detail the top percentile of the population as high need, high cost (HNHC) patients who further contribute to the majority of healthcare spend. Opportunity exists to explore the diversity among ACO structures, their relationship to local environments and influence on top contributors to healthcare spend, like readmissions and high need, high cost populations. The objectives of this study are to better understand existing ACO structures, explore relationships among ACO organizational structures, their local environment in which they operate and directional impact on performance, with emphasis on at risk patients like high need, high cost populations. Theoretically, this study applies Structural Contingency Theory (SCT) for its empirical analyses, specifically a multiple contingency approach. In the extant literature, SCT has not been commonly applied due to its longitudinal nature and limited public access to ACO organizational data. The study sample consists of 45 ACOs that entered into the Medicare Shared Savings Program under Track 1 for the entire term from 2015 to 2017. ACO performance is represented by total shared savings, change in rate of readmissions and change in rate of inpatient psychiatric admissions. Four contingency-structure relationships are analyzed from the National Survey of Accountable Care Organizations and CMS Public Use Files, 1) ACO governance structure and strategy alignment, 2) Interdependency from complex coordination and formalized provider agreement types, 3) interdependency from complex coordination and formalized relationships with mental and behavioral health specialists, and 4) complex coordination and health IT integration and interoperability. Regression analyses were used to analyzed potential misfit and directional impact on performance and the contingency-structure pairs. Results indicate that wide variety exists among ACO structures, that conventional investments in provider agreements and fully integrated health IT do not clearly present positive performance effect. Future research opportunities exist to further examine the impact ACO programs have on meeting community needs and populations. This study offers the theoretical application of a multiple contingency approach from Structural Contingency Theory and a practical exploration of ACO structure, its contextual operations and performance on high need, high cost populations