Business Process Redesign in the Perioperative Process: A Case Perspective for Digital Transformation

This case study investigates business process redesign within the perioperative process as a method to achieve digital transformation. Specific perioperative sub-processes are targeted for re-design and digitalization, which yield improvement. Based on a 184-month longitudinal study of a large 1,157 registered-bed academic medical center, the observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across perioperative sub-processes. This research identifies existing limitations, potential capabilities, and subsequent contextual understanding to minimize perioperative process complexity, target opportunity for improvement, and ultimately yield improved capabilities. Dynamic technological activities of analysis, evaluation, and synthesis applied to specific perioperative patient-centric data collected within integrated hospital information systems yield the organizational resource for process management and control. Conclusions include theoretical and practical implications as well as study limitations

Adoption and Use of Electronic Health Records by Rural Health Clinics: Results of a National Survey [Working Paper]

Rural Health Clinics (RHCs) are a vital source of primary care services with more than 4,000 clinics serving rural communities. Relatively little is known about the extent to which RHCs have adopted and are using electronic health records (EHRs) to support clinical services. Because EHR adoption is an essential element for inclusion in accountable care organizations, patient centered medical homes, and health plan provider networks offered on state and national health insurance marketplaces, EHR implementation will be increasingly important to RHCs if they are to remain competitive participants in the evolving healthcare market. Key Findings: Nearly 72 percent of Rural Health Clinics (RHCs) have an operational electronic health record (EHR), with 63 percent indicating use by 90 percent or more of their staff. Slightly over 17 percent of RHCs without an EHR plan to implement one within six months, and 27 percent plan to do so within seven to twelve months. Common barriers to EHR implementation include acquisition and maintenance costs (72 percent), lack of capital (51 percent), and concerns about productivity and income loss during implementation (45 percent). RHCs continue to lag on some meaningful use measures, but perform well on measures related to clinical care and patient management. With Regional Extension Centers facing the loss of federal funding it is important to identify additional resources to assist RHCs in maximizing EHR adoption and use

Adoption and Use of Electronic Health Records by Rural Health Clinics: Results of a National Survey [Policy Brief]

Rural Health Clinics (RHCs) are a vital source of primary care services with more than 4,000 clinics serving rural communities. Relatively little is known about the extent to which RHCs have adopted and are using electronic health records (EHRs) to support clinical services. Because EHR adoption is an essential element for inclusion in accountable care organizations, patient centered medical homes, and health plan provider networks offered on state and national health insurance marketplaces, EHR implementation will be increasingly important to RHCs if they are to remain competitive participants in the evolving healthcare market. This study demonstrates that RHCs are approaching parity with other physician practices in terms EHR adoption and use, however, some RHCs, such as provider-based clinics, report lower rates of EHR adoption than other clinics. Key Findings: Nearly 72 percent of Rural Health Clinics (RHCs) have an operational electronic health record (EHR), with 63 percent indicating use by 90 percent or more of their staff. Slightly over 17 percent of RHCs without an EHR plan to implement one within six months, and 27 percent plan to do so within seven to twelve months. Common barriers to EHR implementation include acquisition and maintenance costs (72 percent), lack of capital (51 percent), and concerns about productivity and income loss during implementation (45 percent). RHCs continue to lag on some meaningful use measures, but perform well on measures related to clinical care and patient management. With Regional Extension Centers facing the loss of federal funding it is important to identify additional resources to assist RHCs in maximizing EHR adoption and use

The Digital Transformation Journey of a Large Australian Hospital: A Teaching Case

With the vision of a seamless, state-wide approach to patient management, the Department of Health within the Queensland State Government of Australia embarked on a digital transformation journey. This involved the configuration and rollout of an integrated electronic medical record system (ieMR) with computerized provider order entry, ePrescribing, decision support, analytics, and research functionalities, together with new devices and work practices, to create a multi-hospital, whole-of-state digital health ecosystem. Drawing on multiple perspectives, including executives and front-line clinicians who are both optimistic and pessimistic towards the ieMR, this teaching case describes the digital transformation of the lead site, Princess Alexandra Hospital, and their experience in becoming Australia’s first large digital hospital. This case has been informed by a multi-year qualitative study involving the collection of primary (observations and interviews) and secondary data (publicly available project records) before and after the implementation. This case is relevant to undergraduate and postgraduate students in information systems, executive management, and clinical/health informatics

A Case Study Perspective to the Digital Transformation of a Hospital’s Perioperative Process

Based on a 177-month longitudinal study of a large 1,157 registered-bed academic medical center, this research examines the observed effects associated with the digital transformation of a United States hospital’s perioperative process. The observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across the perioperative sub-processes of pre-admissions, pre-operative, intra-operative, post-operative, and central sterile supply. This case study identifies existing perioperative sub-process limitations, potential capabilities, and subsequent sub-process contextual understanding to minimize perioperative process complexity. Specific perioperative nursing documentation as electronic medical records demonstrate the utility and value of patient-centric perioperative data collected within integrated hospital information systems as an organizational resource for process management and control. The case results are discussed, including theoretical and practical implications as well as study limitations

Building Medical Homes in State Medicaid and CHIP Programs

Presents strategies, best practices, and lessons learned from ten states' efforts to advance the medical home model of comprehensive and coordinated care in Medicaid and Children's Health Insurance Programs in order to improve quality and contain costs

Educating Nurses on Workflow Changes from Electronic Health Record Adoption

Workflow issues related to adoption of the electronic health record (EHR) has led to unsafe workarounds, decreased productivity, inefficient clinical documentation and slow rates of EHR adoption. The problem addressed in this quality improvement project was nurses\u27 lack of knowledge about workflow changes due to EHR adoption. The purpose of this project was to identify changes in workflow and to develop an educational module to communicate the changes. This project was guided by both the ADDIE model (analysis, design, development, implementation, and evaluation) and the diffusion of innovations theory. Five stages were involved: process mapping, cognitive walkthrough, eLearning module development, pilot study, and evaluation. The process maps and cognitive walkthrough revealed significant workflow changes particularly in clinical practice guidelines, emergency department treatment plan, and the interdisciplinary care plan. The eLearning module was developed to describe workflow changes using gamification, scenario-based learning, and EHR simulation. The 14-item course evaluation included a 6-point Likert scale and closed- and open-ended questions. A purposive sample of nurses (N = 30) from the emergency department and inpatient care areas were invited to complete the eLearning module and course evaluation. Data were collected until saturation was achieved (n = 15). Descriptive statistics revealed the participants\u27 positive learning experience. This quality improvement project is expected to contribute to positive social change by facilitating the effective use of the new EHR which can improve the quality of patient care, promote patient safety, reduce healthcare costs, and improve patient outcomes

Enhancing Digital Health Literacy to Support Post-Pandemic Health Recovery in Indonesia: A Case Study in Makassar

COVID-19 pandemic has highlighted the importance of information systems to support healthcare planning, management and delivery. Developing countries generally lag in digital transformation, particularly from the perspective of the readiness of human resources to engage with and deliver digital health services. This study explores how digital literacy levels of health workers in Indonesia can be enhanced. We proposed a digital health literacy framework based on a synthesis of existing indicators. Through a case study in Makassar, we reveal that healthcare workers are particularly lacking in digital health data acquisition and management as well as digital health data exchange and analysis. There is also a significant difference between management expectations and the actual healthcare workers\u27 digital literacy levels. This study offers implications to research and practice focusing on enhancing healthcare service quality in developing countries to address the United Nations Sustainable Development Goal of enhancing health and wellbeing for all

Information Systems and Healthcare XXX: Charting a Strategic Path for Health Information Technology

Despite both the slow diffusion of information technology (IT) throughout health organizations and the high cost of implementation, organizations must focus on key strategic applications that deliver high quality care at lower costs. Identifying the strategic applications that support important healthcare processes is challenging. In this article we propose a framework for developing this high level perspective of strategic health information technology (HIT) applications. We then classify into the components of the framework numerous HIT applications and initiatives reported in the media. Based on an existing framework, we identify two critical dimensions that capture two important characteristics of a healthcare delivery process, namely, the degree of mediation and the degree of collaboration. A healthcare process with a high degree of mediation involves a large series of activities in a sequential manner. Processes with a low degree of mediation “understand” that most participants in care delivery contribute directly, often simultaneously, to the final result. The underlying principle for this dimension is the level of functionality of the application. The degree of collaboration refers to the extent to which information is exchanged among the participants in a process. Depending on the degree of exchange, one can identify processes as having higher or lower degrees of collaboration. The underlying principle for this dimension is the degree of interoperability among the applications. Strategic HIT applications lie on a continuum path from a low-high degree of mediation to a low-high degree of collaboration. Our examples show that healthcare delivery organizations evolve their HIT from ad-hoc isolated systems to interoperable, integrated digital health systems. The strategic framework provides a high level perspective of HIT while assisting in the evaluation of potential HIT candidates for implementation