Portal technologies for patient-centred integrated care

Integrated care pathways (ICP) are increasingly used in clinical settings to provide more effective care to patients. ICPs form part of local working agreements to assist co-ordination of multi-disciplinary teams to deliver evidence-based care plans to individual patients. They also document the expected progress of specific patient groups as part of clinical records. To anticipate increased use of ICPs, we have developed Healthcare@Home, a research-phase demonstrator for improving integration of information along the patient path. Healthcare@Home includes support for at-home, in-clinic and mobile wireless sensor devices feeding patient-proximal data hubs, timeline-based physiological trend analysis, data aggregation/dashboarding and individualised risk stratification. These and other decision support tools are embedded in portal designs supporting 'end-to-end' workflows as focused by the composite needs of a National Service Framework (NSF) for patients with diabetes. Healthcare@Home thus represents a scaleable, extensible personalised healthcare information system driven directly from national policy on disease early detection and prevention. Individual portlets have been mapped to stages in the ICP. The portal technologies employed, running on PCs, mobile phones or TVs are capable of highly cost-effective 'end-to-end, anywhere-to-anywhere' information integration

The Development of a Patient Portal for Use During Hospitalization: Pediatric Registered Nurses' Perspectives

Patient portals are innovative digital health technologies that are impacting nursing practice. A patient portal is an electronic tool that allows patients and parents to access personal health information. There has been a recent focus to implement patient portal technology when children are hospitalized. This manuscript style thesis examines pediatric registered nurses (RNs) perspectives of new technology including patient portals and its impact on nursing care. The first manuscript is a thematic literature review that was conducted to determine pediatric health care providers perceptions of patient portal implementation. Five articles were included in the analysis and only two articles focused exclusively on health care providers views. Four themes summarize the pediatric practitioner’s experiences with a portal technology: The Benefits of the Patient Portal; Impact on Provider Workload; User-Friendliness of the Patient Portal; and Health Care Providers Needs with Portal Implementation. Pediatric RNs voices are limited in currently published research. Therefore, the second manuscript is an interpretive description study conducted to explore pediatric RNs perspectives of new technology, including a proposed patient portal, on patient care. A total of 10 nurses participated in a semi-structured individual interview. Six themes represent the RNs views of new technology, including a proposed patient portal, and the impact on nursing care during a child’s hospitalization. The first three themes: Standing in Both Worlds, Reshaping the Care Triad, and Needing Support embody the nurses’ views on the implementation of technology in the pediatric inpatient units they work. The RNs previous experience with health technology implementation informs their perspectives of a new portal technology and its potential impact on patient care. The last three themes encompass the RNs views on the development of a patient portal: Improving Family Centred Care, Connecting with Care, and Anticipating Nursing Implications. Overall, the RNs are anticipating a positive impact the portal can have on the hospital experience for children and their family members. Even though the nurses report a feeling of standing in both worlds in regards to technology and its varied implementation, they are still optimistic. The RNs are also bringing awareness to the impact of all the new technology, not just a single piece, on patient care and the art of nursing. The integrated discussion provides recommendations to a larger ongoing study and discusses the impact on nursing practice, education, and research. Recruiting and involving pediatric RNs can take considerable time and effort but they can provide valuable insight and feedback on new technology, including patient portals, which may result in more sustained use.

A manifesto for a socio-technical approach to NHS and social care IT-enabled business change - to deliver effective high quality health and social care for all

80% of IT projects are known to fail. Adopting a socio-technical approach will help them to succeed in the future. The socio-technical proposition is simply that any work system comprises both a social system (including the staff, their working practices, job roles, culture and goals) and a technical system (the tools and technologies that support and enable work processes). These elements together form a single system comprising interacting parts. The technical and the social elements need to be jointly designed (or redesigned) so that they are congruent and support one another in delivering a better service. Focusing on one aspect alone is likely to be sub-optimal and wastes money (Clegg, 2008). Thus projects that just focus on the IT will almost always fail to deliver the full benefits

MOSAIC roadmap for mobile collaborative work related to health and wellbeing.

The objective of the MOSAIC project is to accelerate innovation in Mobile Worker Support Environments. For that purpose MOSAIC develops visions and illustrative scenarios for future collaborative workspaces involving mobile and location-aware working. Analysis of the scenarios is input to the process of road mapping with the purpose of developing strategies for R&D leading to deployment of innovative mobile work technologies and applications across different domains. One of the application domains where MOSAIC is active is health and wellbeing. This paper builds on another paper submitted to this same conference, which presents and discusses health care and wellbeing specific scenarios. The aim is to present an early form of a roadmap for validation

ITC SOLUTIONS TO ACHIEVE PERFORMANCE AND EFFICIENCY OF HEALTH SERVICES:ONLINE VIRTUAL CLINIC

The digital era modified the way people work, how the information and the informational resources are defined and organized. The organization which holds, uses and correctly reproduces the piece of information, the knowledge, the intellectual capital, becomes a leader in the proper field of activity. Following the actual tendencies in the digital era connected to the exchange of professional information, I can say that the exchange and sharing of digital information in a global multitude of interconnected computers are essential instruments that can contribute to the development and consolidation of the intellectual potential of the organization. This is why, the access of the individuals to information is an actual requirement of the development of the Romanian society in the context of globalization and world implication o contemporary processes and phenomena. The Digital integration eliminates the barriers that traditionally suppress the circuit of the medical information, lets the goods and services circulate to and from Romania by promoting efficiency as final purpose. Performance is needed in the health system, the transformation of the system of medical services by bringing the benefits of the medical science and technology to all individuals from every community. In order to accomplish these expectations it is needed that all the components that form the health system look at it as a whole and subscribe to modern solutions for improvement so that the quality of health should raise to an unprecedented level. Even if health systems differ from country to country from the organizational and financial point of view, they face the same challenges and problems, respectively the supply of medical care of better quality and keeping under control the health expenses. The use of information and communication technology in the field of medical assistance in order to stock, share, transmit and analyze clinical data and knowledge is more necessary than ever.Internet, communication in real time, health system, medical information system, digital integration, virtual medical assistance, virtual clinic, shared medical information

Addendum to Informatics for Health 2017: Advancing both science and practice

This article presents presentation and poster abstracts that were mistakenly omitted from the original publication

Unlocking medical leadership’s potential:a multilevel virtuous circle?

Background and aim: Medical leadership (ML) has been introduced in many countries, promising to support healthcare services improvement and help further system reform through effective leadership behaviours. Despite some evidence of its success, such lofty promises remain unfulfilled. Method: Couched in extant international literature, this paper provides a conceptual framework to analyse ML's potential in the context of healthcare's complex, multifaceted setting. Results: We identify four interrelated levels of analysis, or domains, that influence ML's potential to transform healthcare delivery. These are the healthcare ecosystem domain, the professional domain, the organisational domain and the individual doctor domain. We discuss the tensions between the various actors working in and across these domains and argue that greater multilevel and multistakeholder collaborative working in healthcare is necessary to reprofessionalise and transform healthcare ecosystems

Pick-n-mix approaches to technology supply : XML as a standard “glue” linking universalised locals

We report on our experiences in a participatory design project to develop ICTs in a hospital ward working with deliberate self-harm patients. This project involves the creation and constant re-creation of sociotechnical ensembles in which XML-related technologies may come to play vital roles. The importance of these technologies arises from the aim underlying the project of creating systems that are shaped in locally meaningful ways but reach beyond their immediate context to gain wider importance. We argue that XML is well placed to play the role of "glue" that binds multiple such systems together. We analyse the implications of localised systems development for technology supply and argue that inscriptions that are evident in XML-related standards are and will be very important for the uptake of XML technologies

Digital Health’s Impact on Integrated Care, Carer Empowerment and Patient-Centeredness for Persons Living With Dementia

E-health or digital health technologies endeavour to connect key stakeholders and thereby lay the foundation for better integrated as well as potentially more patient-centered care. However, despite the promise of empowerment, efficiency and value, digital health has yet to become part of the daily lives of the people who care for persons living with dementi

Electronic health record portals adoption by health care consumers

A thesis submitted in partial fulfillment of the requirements for the degree of Doctor in Information Management Specialization in Information and Decision SystemsElectronic Health Record (EHR) portals, also called EHR patient portals, have received great attention and investment at the government level worldwide, like the multi-billion dollar US initiative, named meaningful use program. According to the literature review, there is still a lack of studies that address the topic of understanding why people adopt and use EHR Portals, making this a field of knowledge that requires more research. According to the findings in the literature review the complexity of EHR portals requires having a patient-centred model that should be able to cover additional dimensions related with health behaviour, confidentiality concerns, and innovation drivers. Potential adoption differences between countries with different regulations in their health care systems should also be tested. With this dissertation, we contribute to a better understanding of the factors that lead health care consumers to use and adopt EHR portals. To this end we develop four empirical studies. In the first empirical study (Chapter 3) we tested the Extended Unified Theory of Acceptance and Use of Technology (UTAUT2) in Portugal. Being a consumer- centred model, it was important to evaluate its feasibility to study the EHR portals adoption determinants by the health care consumers. Several constructs in the model helped explain the adoption of EHR portals: performance expectancy, effort expectancy, social influence and habit. With habit a consumer specific construct from UTAUT2 having the most relevant impact in both behavioural intention and use. UTAUT2 showed its importance as a consumer-focused model identifying the factors that drive health care consumers to use EHR portals. In the second empirical study (Chapter 4) -also tested in Portugal- we extended the UTAUT2 model by adding a health specific construct, self-perception. This construct showed its relevance by being a statistically significant predictor of behavioural intention, demonstrating the usefulness of including a construct derived from the Health Belief Model (HBM), in a technology applied in the field of health care. In the third empirical study (Chapter 5) we performed a cross-country analysis between US and Portugal combining UTAUT2 with the Concern for Information Privacy (CFIP) framework. We made an assessment of the potential differences between the determinants of adoption between the two countries with different health care regulations and health care models. In the US there is no national health system (NHS) coverage and the patients need to have an expensive private insurance or pay directly to the health care provider to have health care support, while in Portugal there is universal health coverage. It was hypothesized and confirmed via the price value construct that the value that the US health care consumers give to a tool like EHR portals is statistically significantly greater than the Portuguese health care consumers. It was also expected that confidentiality concerns in US are greater than in Portugal, due to the less strict regulation in US regarding patient data confidentiality. This was measured by the CFIP framework, but confidentiality concerns were not an issue in either US or Portugal. Social influence, hedonic motivation, and price value were predictors only in the US group. With this study we verified the importance to perform cross-country evaluations when studying EHR portals adoption. In the fourth empirical study (Chapter 6) we used the evidence from the previous empirical studies plus the literature review to propose a new research model that integrates constructs from UTAUT2, HBM, and the Diffusion of Innovation (DOI) theory. In this study, we performed a national survey based on randomly generated mobile phone numbers, when in the previous empirical research, we targeted our sample to educational institutions. We used a two-phase sampling approach. In the first phase, we asked potential respondents if they were users of EHR portals and if yes, if she/he was interested in replying to our main survey (second phase). From this sample regarding the question to identify the users of EHR portals, we obtained 8.6% EHR portals usage in the adult Portuguese population. A relevant contribution from our study to understand the usage of this type of technology at country level. All three theories contributed with constructs that help to understand EHR portals adoption. The final research model obtained the best results from the all of the empirical studies executed in this dissertation with 76.0% of variance explained in behavioural intention and 61.8% of variance explained in use behaviour. In this dissertation’s conclusions (Chapter 7), we provide more detailed insights about the overall contributions of this dissertation, managerial implications to develop and implement better EHR portals, limitations and avenues for future research about EHR portals.Os Portais de Registo de Saúde Eletrónicos (PRSE), também denominados portais do doente, têm recebido bastante atenção e investimentos a nível governamental em todo o Mundo, tendo como exemplo a iniciativa multibilionária “meaningful use program” nos Estados Unidos da América. De acordo com a revisão da literatura, ainda existe uma lacuna no estudo das razões pelas quais as pessoas adotam e usam os PRSE, fazendo desta uma área de conhecimento que necessita de mais investigação. De acordo com a revisão da literatura, a complexidade dos PRSE, requere um modelo centrado no doente e que seja capaz de cobrir dimensões adicionais relacionadas com o comportamento na saúde, preocupações de confidencialidade e inovação. Potenciais diferenças na adoção entre países com diferentes regulamentações nos sistemas de saúde também deverão ser testadas. Com esta dissertação procuramos contribuir para um melhor conhecimento dos fatores que levam os consumidores na saúde a usar e adotar PRSE. Com este propósito desenvolvemos quatro estudos empíricos. No primeiro estudo empírico (Capítulo 3), testamos em Portugal o modelo de “Extended Unified Theory of Acceptance and Use of Technology” (UTAUT2). Sendo um modelo centrado no consumidor, era importante avaliar a sua adequação para estudar os determinantes de adoção dos PRSE pelos consumidores na saúde. Vários fatores no modelo ajudaram a explicar a adoção dos PRSE: expectativa de desempenho, expectativa de esforço, influência social e hábito. Sendo o hábito um fator especifico da área do consumidor do UTAUT2, demonstrou este fator o impacto mais relevante tanto na intenção de uso como no uso efetivo. O UTAUT2 demonstrou a sua importância como um modelo centrado no consumidor, identificando os fatores que influenciam os consumidores na saúde a usarem PRSE. No segundo estudo empírico (Capítulo 4), também testado em Portugal, estendemos o modelo de UTAUT2, adicionando um fator especifico da saúde, auto- perceção. Este fator demonstrou a sua relevância, tendo uma influência estatisticamente significativa sobre a intenção de uso, demonstrando a utilidade de incluir um fator derivado do “Health Belief Model”(HBM), numa tecnologia aplicada à saúde. No terceiro estudo empírico (Capítulo 5), executamos uma análise entre os Estados Unidos da América e Portugal combinando o UTAUT2 e o “Concern For Information Privacy” (CFIP). Foi feita uma avaliação das potenciais diferenças entre os dois países, com diferentes regulamentações e modelos de saúde, no que diz respeito aos determinantes de adoção. Nos Estados Unidos não existe um sistema nacional de saúde e os doentes têm de ter um seguro privado de saúde bastante dispendioso ou pagarem diretamente as suas despesas ao prestador dos cuidados de saúde, por sua vez em Portugal existe uma cobertura universal dos cuidados de saúde. Foi testada e confirmada a hipótese através do fator preço-valor, que nos Estados Unidos da América, o valor que os consumidores na saúde dão aos PRSE é maior do que em Portugal, sendo esta diferença estatisticamente significativa. Também seria esperado que as preocupações com a confidencialidade fossem maiores nos Estados Unidos da América do que em Portugal, devido a uma regulamentação menos restritiva nos Estados Unidos da América relativamente à confidencialidade dos dados clínicos dos doentes. Utilizamos o CFIP para este propósito, no entanto as preocupações relativamente à confidencialidade, não demonstraram ser um problema tanto nos Estados Unidos da América como em Portugal. A influência social, motivação hedónica e preço-valor, foram fatores relevantes apenas nos Estados Unidos da América. Com este estudo, verificamos que é importante fazer comparações entre países para estudar a adoção de PRSE. No quarto estudo empírico (Capítulo 6), utilizamos a evidência dos estudos empíricos anteriores e da revisão da literatura para propor um novo modelo que integra fatores do UTAUT2, HBM e “Diffusion of Innovation” (DOI). Neste estudo foi feita uma sondagem nacional, utilizando uma amostra aleatória de números de telemóvel, enquanto que nos estudos empíricos anteriores, utilizamos amostras obtidas em instituições com fins educacionais. No processo de amostragem utilizamos duas fases. Na primeira fase perguntamos aos inquiridos se eram utilizadores de PRSE e só depois se a reposta fosse afirmativa se estariam interessados em responder ao inquérito principal do estudo (segunda fase). Desta amostragem e relativamente à questão utilizada para identificar utilizadores de PRSE obtivemos 8.6% de uso na população adulta portuguesa. Uma contribuição importante do nosso estudo para o entendimento da utilização deste tipo de tecnologia ao nível de um país. As três teorias contribuíram com fatores que ajudam a compreender a adoção de PRSE. O modelo final obteve os melhores resultados de todos os estudos empíricos desta dissertação com 76.0% da variância explicada em intenção de uso e 61.8% da variância no uso. Nas conclusões desta dissertação (Capítulo 7), é descrito em maior detalhe todas as contribuições desta dissertação, implicações para decisões de gestão relativamente ao desenvolvimento e implementação de melhores PRSE e limitações e novos caminhos de investigação a ser seguidos para os PRSE