Factors associated with adoption of the electronic health record system among primary care physicians

Background: A territory-wide Internet-based electronic patient record allows better patient care in different sectors. The engagement of private physicians is one of the major facilitators for implementation, but there is limited information about the current adoption level of electronic medical record (eMR) among private primary care physicians. Objective: This survey measured the adoption level, enabling factors, and hindering factors of eMR, among private physicians in Hong Kong. It also evaluated the key functions and the popularity of electronic systems and vendors used by these private practitioners. Methods: A central registry consisting of 4324 private practitioners was set up. Invitations for self-administered surveys and the completed questionnaires were sent and returned via fax, email, postal mail, and on-site clinic visits. Current users and non-users of eMR system were compared according to their demographic and practice characteristics. Student’s t tests and chi-square tests were used for continuous and categorical variables, respectively. Results: A total of 524 completed surveys (response rate 524/4405 11.90%) were collected. The proportion of using eMR in private clinics was 79.6% (417/524). When compared with non-users, the eMR users were younger (users: 48.4 years SD 10.6 years vs non-users: 61.7 years SD 10.2 years, P<.001); more were female physicians (users: 80/417, 19.2% vs non-users: 14/107, 13.1%, P=.013); possessed less clinical experience (with more than20 years of practice: users: 261/417, 62.6% vs non-user: 93/107, 86.9%, P<.001); fewer worked under a Health Maintenance Organization (users: 347/417, 83.2% vs non-users: 97/107, 90.7%, P<.001) and more worked with practice partners (users: 126/417, 30.2% vs non-users: 4/107, 3.7%, P<.001). Efficiency (379/417, 90.9%) and reduction of medical errors (229/417, 54.9%) were the major enabling factors, while patient-unfriendliness (58/107, 54.2%) and limited consultation time (54/107, 50.5%) were the most commonly reported hindering factors. The key functions of computer software among eMR users consisted of electronic patient registration system (376/417, 90.2%), drug dispensing system (328/417, 78.7%) and electronic drug labels (296/417, 71.0%). SoftLink Clinic Solution was the most popular vendor (160/417, 38.4%). Conclusions: These findings identified several physician groups who should be targeted for more assistance on eMR installation and its adoption. Future studies should address the barriers of using Internet-based eMR to enhance its adoption

Visionary 2008

https://nsuworks.nova.edu/hpd_opt_visionary/1002/thumbnail.jp

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

Sustainable Paths for Data-Intensive Research Communities at the University of Melbourne: A Report for the Australian Partnership for Sustainable Repositories

This report presents the local project findings with a view to identifying how these findings may add to the knowledge base for informing an e-research strategy for the University of Melbourne. It also provides important considerations for how major Government initiatives in research policy and funding might impact on research data and records management requirements. Eleven research communities from diverse disciplines were consulted for an audit of their data management practices. Researchers from these communities represent a number of diverse disciplines: Applied Economics; Astrophysics; Computer Science and Software Engineering; Education; Ethnography; Experimental Particle Physics; Humanities informatics; Hydrology and Environmental Engineering; Linguistics; Medical informatics; Neuroscience and the Performing Arts. In addition to the specific findings for each group audited, the project findings also provide information about sustainability issues around research data management practices at the university

Issues of the adoption of HIT related standards at the decision-making stage of six tertiary healthcare organisations in Saudi Arabia

Due to interoperability barriers between clinical information systems, healthcare organisations are facing potential limitations with regard to acquiring the benefits such systems offer; in particular, in terms of reducing the cost of medical services. However, to achieve the level of interoperability required to reduce these problems, a high degree of consensus is required regarding health data standards. Although such standards essentially constitute a solution to the interoperability barriers mentioned above, the level of adoption of these standards remains frustratingly low. One reason for this is that health data standards are an authoritative field in which marketplace mechanisms do not work owing to the fact that health data standards developed for a particular market cannot, in general, be applied in other markets without modification. Many countries have launched national initiatives to develop and promote national health data standards but, although certain authors have mapped the landscape of the standardisation process for health data in some countries, these studies have failed to explain why the healthcare organisations seem unwilling to adopt those standards. In addressing this gap in the literature, a conceptual model of the adoption process of HIT related standards at the decision-making stage in healthcare organisations is proposed in this research. This model was based on two predominant theories regarding IT related standards in the IS field: Rogers paradigm (1995) and the economics of standards theory. In addition, the twenty one constructs of this model resulted from a comprehensive set of factors derived from the related literature; these were then grouped in accordance with the Technology-Organisation Environment (TOE), a well-known taxonomy within innovation adoption studies in the IS field. Moving from a conceptual to an empirical position, an interpretive, exploratory, multiple-case study methodology was conducted in Saudi Arabia to examine the proposed model. The empirical qualitative evidence gained necessitated some revision to be made to the proposed model. One factor was abandoned, four were modified and eight new factors were added. This consistent empirical model makes a novel contribution at two levels. First, with regard to the body of knowledge in the IS area, this model offers an in-depth understanding of the adoption process of HIT related standards which the literature still lacks. It also examines the applicability of IS theories in a new area which allows others to relate their experiences to those reported. Secondly, this model can be used by decision makers in the healthcare sector, particularly those in developing countries, as a guideline while planning for the adoption of health data standards

Medical device Contract Research Organization (CRO) as Knowledge-Intensive Business Services (KIBS): exploring China's innovative medical device sector

China has witnessed rapid economic growth in the past 40 years of economic reform and opening up. In this context, healthcare development and innovation dynamics is of great significance in China's modern economy. In particular, sectors like medical equipment and devices are one of the pillars of Chinese healthcare system. Due to the soaring costs of medical devices technical change and strict government supervision, R&D outsourcing of the medical device sector to specialized service entities known as CROs (contract research organizations) has attracted more and more attention. In this Thesis, CROs are seen as knowledge-intensive business services (KIBS) in the evolving national innovation system of China since they act as innovation intermediaries to promote the effective use of knowledge in society. To explore the development of KIBS innovative performance of Chinese medical device CROs, qualitative methodological approach is adopted. Semi-structured interviews were conducted with 20 experts from four different groups of key stakeholders of medical device CROs. Six findings are drawn from the key points expressed by the interviewees, forming a guidance for the further innovation of medical device CROs: (1) CROs can be extended by vertical integration, providing inclusive services; (2) CROs can be transformed by information technologies and digitalization; (3) CROs need to develop quick response capabilities through fast delivery; (4) CROs can be optimized by better resource allocation; (5) CROs need to provide an incentive scheme; and (6) CROs need to focus on reputational capital. The results show that Chinese medical device CROs perform innovation activities in a way compatible with the KIBS concept, and thus directly affect the economic competitiveness of the medical device sector in China.A China testemunhou um rápido crescimento económico nos últimos quarenta anos com as políticas de Reforma e abertura. A inovação nos cuidados de saúde é de grande importância na economia moderna e na China. O sector de dispositivos farmacêuticos e médicos é um pilar do sistema de saúde chinês. Devido aos custos crescentes dos dispositivos médicos e à supervisão estrita do governo, a terceirização de I&D do setor de dispositivos médicos para CROs (organizações de investigação por contrato) atraiu cada vez mais atenção. Os CRO são aqui vistos como serviços profissionais intensivos em conhecimento (KIBS) no sistema nacional de inovação, uma vez que actuam como intermediários de inovação para promover o uso efectivo do conhecimento na sociedade. Para explorar o desenvolvimento do desempenho inovador do CRO de dispositivos médicos chineses é adoptada neste estudo uma metodologia baseada em entrevistas qualitativas semi-estruturadas. Entrevistas semi-estruturadas foram conduzidas com vinte especialistas de quatro grupos diferentes das principais partes interessadas na área dos dispositivos médicos. Seis proposições-chave são retiradas da evidência expressa pelos entrevistados, formando uma orientação para a futura inovação nos CROs: (1) os CROs podem ser alargados pela integração vertical, fornecendo serviços inclusivos; (2) os CRO podem ser transformados pela digitalização; (3) os CRO precisam de dar respostas rápidas; (4) Os CROs podem ser optimizados por uma melhor alocação de recursos; (5) Os CROs podem beneficiar de esquemas de incentivos; e (6) Os CROs precisam de um foco no capital reputacional. Os resultados mostram que OS CRO de dispositivos médicos chineses exercem actividades de inovação de UMA forma compatível com o conceito de KIBS, afectando assim directamente a competitividade económica do sector dos dispositivos médicos na China. Por outro lado, a CROs de dispositivos médicos, enquanto KIBS, são um factor crucial para facilitar o processo de I&D nos produtos farmacêuticos e no sector da biotecnologia

Development of evidence-based behavioural interventions to reduce inappropriate use of antibiotics beyond clinical settings

Human use of antibiotics in China accounts for a quarter of worldwide antibiotic consumption and mainly occurs in outpatient and community settings. Non-clinical factors for antibiotic use are main drivers of its excessive consumption. To date, almost every intervention has focused exclusively on antibiotic prescribing behaviours, with little attention being paid to antibiotic consumer’s usage behaviours in the community. This PhD study aimed to develop an evidence-based, theory-informed behavioural change intervention to reduce inappropriate use of antibiotics in the Chinese communities. To conduct this programme of research, I employed a mixed-methods approach throughout the study phases, which included: 1) systematic literature reviews on determinants of antibiotic use in China and on behavioural change interventions to reduce unnecessary or inappropriate use of medical interventions, 2) secondary data analyses of large-scale population data on antibiotic use-related knowledge and practice, 3) formative interviews to ensure acceptability and feasibility of proposed interventions, and finally 4) a mixed-methods feasibility evaluation of the pilot intervention. The systematic reviews identified non-clinical factors and potential pathways influencing public’s antibiotic use, and the components of promising behavioural change interventions. Using the survey data, some of the pathways were quantitatively assessed to inform the development of a context-appropriate intervention - reducing access to non-prescription antibiotics in rural China was identified to be a priority. Additionally, (mis-)perceived antibiotic efficacy for upper respiratory tract infections (URTIs) was found to be associated with increased odds of antibiotic use in the community. The new knowledge contributed to the design of the proposed intervention. Working with local partners, I developed and conducted a feasibility assessment of a pilot antibiotic take-back programme aiming to reduce household antibiotic storage and unsafe disposal in rural China. The proposed intervention was deemed feasible and appropriate