The MyHealthRecord System in General Practices: Steps Towards Adoption Sustainability

Digital health systems such as MyHealthRecord (MyHR) are aimed at enabling the accessibility of health records whenever and wherever, assisting users in making more informed decisions about patient care. This research explored MyHR adoption (Victoria) and user views/experiences in general practice organisations (GPO). Although adoption of MyHR in GPO was encouraged in July 2016, system use was limited, adapting ad hoc procedures mostly to satisfy funding criteria. This paper brings recommendations for GPO and policy makers, referring to lessons from GP computerisation. The adoption triangle theory was contextualised, encapsulating three main themes: (1) To understand and identify ‘needs’ of GPOs/patients, promoting cultural shift among GPOs and the community; (2) ‘Enhance support’ to address these needs, including three themes related to users and GPO engagements, and a formal change-management approach; (3) ‘Review incentive’ to increase system education and interaction, hence increasing the likelihood of adoption sustainability

Health Information Science: 7th International Conference, HIS 2018, Cairns, QLD, Australia, October 5–7, 2018, Proceedings

[Extract] The International Conference Series on Health Information Science (HIS) provides a forum for disseminating and exchanging multidisciplinary research results in computer science/information technology and health science and services. It covers all aspects of health information sciences and systems that support health information management and health service delivery. The 7th International Conference on Health Information Science (HIS 2018) was held in Cairns, Queensland, Australia, during October 5–7, 2018. Founded in April 2012 as the International Conference on Health Information Science and Their Applications, the conference continues to grow to include an ever-broader scope of activities. The main goal of these events is to provide international scientific forums for researchers to exchange new ideas in a number of fields that interact in depth through discussions with their peers from around the world. The scope of the conference includes: (1) medical/health/biomedicine information resources, such as patient medical records, devices and equipments, software and tools to capture, store, retrieve, process, analyze, and optimize the use of information in the health domain; (2) data management, data mining, and knowledge discovery, all of which play a key role in decision-making, management of public health, examination of standards, privacy and security issues; (3) computer visualization and artificial intelligence for computer-aided diagnosis; and (4) development of new architectures and applications for health information systems

Pharmacists' Perspectives on the Use of My Health Record

Background: My Health Record (MHR) is a relatively new nationwide Australian digitalhealth record system accessible by patients and a range of healthcare professionals. Pharmacists willbe key contributors and users of the MHR system, yet little is known about the perceived barriers andbenefits of use. (2) Objective: To explore pharmacists’ perspectives related to potential benefits andbarriers associated with use of MHR. (3) Methods: An online survey was developed and face-validated.The survey was advertised to Australian pharmacists on pharmacy professional bodies’ websites. Thiswas a cross-sectional study using an anonymous questionnaire. Descriptive statistics were used todescribe the distribution of the data. Chi-square, Kendall’s tau coefficient (tau-c) and Kruskal–Wallistests were used to examine the relationships where appropriate. (4) Results: A total of 63 pharmacistscompleted the survey. The majority of respondents worked in a metropolitan area (74%), and themost common workplace setting was community pharmacy (65%). Perceived benefits identifiedby responders include that the use of MHR would help with continuity of care (90%), and that itwould improve the safety (71%) and quality (75%) of care they provided. Importantly, more thanhalf of pharmacists surveyed agreed that MHR could reduce medication errors during dispensing(57%) and could improve professional relationships with patients (57%) and general practitioners(59%). Potential barriers identified by pharmacists included patients’ concerns about privacy (81%),pharmacists’ own concern about privacy (46%), lack of training, access to and confidence in using thesystem. Sixty six percent of respondents had concerns about the accuracy of information containedwithin MHR, particularly among hospital and general practice pharmacists (p = 0.016) and almosthalf (44%) had concerns about the security of information in the system, mainly pharmacists workingat general practice and providing medication review services (p= 0.007). Overall satisfaction withMHR varied, with 48% satisfied, 33% neither satisfied nor dissatisfied, and 19% dissatisfied, witha higher satisfaction rate among younger pharmacists (p = 0.032). (5) Conclusions: Pharmacistsconsidered that the MHR offered key potential benefits, notably improving the safety and quality ofcare provided. To optimize the use of MHR, there is a need to improve privacy and data securitymeasures, and to ensure adequate provision of user support and education surrounding the ability tointegrate use of MHR with existing workflows and software

Relatedness and Compatibility: Semantic Dimensions of the Concept of Privacy in Chinese and English Corpora

This dissertation is a study of how privacy as an ethical concept exists in two languages: Mandarin Chinese and American English. The assumption for this dissertation is that different languages will have their own distinctive expressions and understandings when it comes to privacy. Specifically, I have proposed a cross-genre and cross-language study to include two genres of language corpora for each of the languages: social media posts and news articles. In addition, the language corpora span from 2010 to 2019, which supported an observation of how privacy-related languages may have changed and evolved over the years. I took a mixed-methods approach, by using two computational methods: semantic network analysis (SNA) and structural topic modeling (STM) for processing the natural language corpora. When it comes to labeling and interpreting the results of topic modeling, I relied on external coders for labeling and my own in-depth reading of the topic words as well as original documents to make sense of the meaning of these topics. Last but not least, based on the interpretations of topics, I proposed four semantic dimensions and used these four dimensions to come back to code all the topics to have an overall depiction of the topics across these two languages and two genres. The four semantic dimensions, though were found present in both languages, have revealed unequal presence in the two languages. Specifically, the institution dimension has much more presence in the English language; and in the Chinese language, it is the individual dimension that is frequently seen across topics in both genres. Apart from topics, this different emphasis on these two semantic dimensions (institution and individual) is also reflected through the semantic network analysis of nodes where the nodes with leading centrality scores over the years in these two languages differ. After considering the limitation of the data in this study, I conclude by arguing that overall, it is more cautious and appropriate to understand the incompatibilities by saying the two languages differ by their emphasis on different dimensions. This study is one of the first empirically-grounded intercultural explorations of the concept of privacy. It not only provides an examination of the concept as it is understood at the current time of writing but also reveals that natural language is promising to operationalize intercultural privacy research and comparative privacy research.Doctor of Philosoph

DEVELOPMENT OF NATIONAL AND SUB-NATIONAL ELECTRONIC HEALTH RECORDS TO ENABLE HEALTH DATA EXCHANGE FOR IMPROVED MATERNAL HEALTH SERVICE DELIVERY AND PROGRAM: THE CASE OF A TERTIARY CARE STATE GOVERNMENT HOSPITAL IN INDIA

Despite the fact that understanding stakeholders and their health information needs, health data systems, and workflows are essential for the development of electronic health records to enable inter-organizational health data exchange for decision-making, there is limited research evidence about how to enable inter-organizational health data exchange in India. A qualitative case study focused on a tertiary care state government hospital in India was conducted. The study aimed to identify factors that favor or hampered development of electronic health records, document and describe stakeholder, their health information needs, data systems and workflows associated with maternal health, and proposed a health data exchange model for improving maternal health services and programs at hospital, state, and national levels. The study applied purposive sampling to identify and collect data from twenty key informants using key informant interview technique. Inductive analysis was conducted. The findings suggested that leadership support and coordination, budgetary constraint, centralized decision-making authority, siloed data collection and reporting systems, shortage of workforce, gaps in health information technology education and training, and poor system design affected development of health data exchange. The findings showed national level agencies were driving adoption and use of electronic health records, provision of financial incentives, program development and had limited engagement of the state and hospital level stakeholders. Both electronic and paper-based data collection, storage, and data sharing systems and the processes and the workflows were complex and ad-hoc. Following an iterative design process and based on the essential requirements suggested by the key informants an interorganizational health data exchange model was developed. The proposed model leverages electronic heath records to enable use of data for patient care, and reuse of data to support management and administrative decisions at hospital, state, and national levels. The model shows how to balance inter- and intra-organizational data exchange needs. The study also offers five recommendations to facilitate the operationalization of the health data exchange model. The study adds to the current knowledge base and calls for additional research focused on strengthening use and reuse of data for clinical and public health decision making at different health system levels.Doctor of Philosoph

Co-creation of a person-centred integrated digital health model of care for fragility hip fractures: a mixed methods pragmatic research

Hip fracture is among the most devastating events faced by older people. These fragility fractures often occur due to trivial or low trauma falls. Current treatment efforts have led to best practice management guidelines and clinical audits at the level of the acute hospital setting and, to a certain extent, immediate post-hospital discharge. However, concerns still exist in the areas of prevention and rehabilitation outcomes including quality of life, and functional independence. Based on emerging evidence, a more nuanced approach is required for future health services delivery which incorporates: 1) musculoskeletal health; 2) increasing burden of multimorbidities; and 3) societal influences and circumstances shaping individual’s health literacy including access to digital technology. The aim of this thesis work is to conduct a program of research focused on establishing a personcentred and integrated model of care for older people with hip fractures assisted by digital health technology and modern educational approaches. The goal is to improve outcomes such as health literacy, access, functional rehabilitation, and quality of life. Objectives 1. To map out digital health interventions by conducting a comprehensive systematic review, which evaluates the effectiveness of digital health supported targeted patient communication versus usual provision of health information, on the recovery from fragility fractures. 2. To determine different phases of a research program for the development of a digital health hub enabled model of care focused on hip fracture rehabilitation through a dynamic conceptual framework. 3. To understand the perspective of older people with hip fractures, their family members, and residential aged carers, to inform the development of a personalised digital health hub and factors impacting the likelihood of potential usage. 4. To understand the perspectives of clinicians from various medical and surgical disciplines, allied health, and other relevant non-health stakeholders to inform the development of a digital health enabled model of care for fragility fractures. 5. To examine the process and management of innovation, and the strategic directions required to improve musculoskeletal healthcare at macro (policy), meso (service delivery), and micro (clinical practice) levels and discuss the critical role of different stakeholders in driving innovations in healthcare. 6. To describe a vision for future health care to address increasing population multimorbidity through the co-creation of personalised digital health hubs that recognise the importance of patient agency in driving the evolution of health services. This study emphasises that digital health solutions must be co-created and co-implemented by engaging relevant stakeholders including end consumers at the local contextual level. Developed countries such as Australia are emerging global leaders in contemporary research focused on advancing knowledge and filling gaps within existing health service delivery for older people.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 202