IT in Healthcare: an Integrative Study of Organizational Change

Research on Healthcare IT is a highly multidisciplinary field. Each stream of research brings a certain focus and contributionsto our understanding of the role of technology in healthcare. However, this high multidisciplinary can be confusing as theresults and implications of the different streams may look incommensurable. This paper looks at various streams of researchon health IT and presents an integrative framework that utilizes organizational change to understand how different researchstreams on health IT interrelate and contradict in terms of their focus, contributions and implications. We argue that such anintegrative understanding is the key to capture the complexity of health IT projects and ensure their success

SIMULATED MEDICAL ENCOUNTERS TO ANALYZE PATIENT-PHYSICIAN COMMUNICATION DURING ELECTRONIC MEDICAL RECORDS\u27 USE IN PRIMARY CARE

The implications of the patient-physician relationship and communication on healthcare quality have been widely discussed in previous research. Communication has been characterized as one of the most powerful, encompassing, and versatile instruments available to the physician and it has been suggested that good patient-physician communication can improve healthcare outcomes. The incorporation of Electronic Medical Records (EMRs) in primary care provides an opportunity for improving healthcare services and quality of care. EMRs have, without a doubt, transformed the dynamics of the medical encounter. Implications of EMRs on the patient-physician communication, and thus on healthcare quality, have not yet reached a full understanding. Existing physician communication skills assessment tools do not take into account the physician\u27s need to divert his/her attention from the patient to the computer, and vise versa. One such tool is the SEGUE. This research-in-progress paper aims to describe the preliminary steps taken to assess the adequacy of the existing SEGUE tool in evaluating physicians\u27 communication skills in a computerized environment based on simulated medical encounters. Assuming that the existing SEGUE tool does not capture the new dynamics of the medical encounter; we suggest that it should be enhanced to include best-practices for physicians\u27 EMR use while maintaining effective communication with patients. We intend to develop a set of items which reflect recommendations for EMR use aimed at maintaining effective communication with the patient. These new items will be formulated based on an extant literature review and experts panel, and will eventually be incorporated into the existing SEGUE tool to provide a comprehensive tool for analyzing physicians\u27 communication skills in the computerized clinic

A standards-based ICT framework to enable a service-oriented approach to clinical decision support

This research provides evidence that standards based Clinical Decision Support (CDS) at the point of care is an essential ingredient of electronic healthcare service delivery. A Service Oriented Architecture (SOA) based solution is explored, that serves as a task management system to coordinate complex distributed and disparate IT systems, processes and resources (human and computer) to provide standards based CDS. This research offers a solution to the challenges in implementing computerised CDS such as integration with heterogeneous legacy systems. Reuse of components and services to reduce costs and save time. The benefits of a sharable CDS service that can be reused by different healthcare practitioners to provide collaborative patient care is demonstrated. This solution provides orchestration among different services by extracting data from sources like patient databases, clinical knowledge bases and evidence-based clinical guidelines (CGs) in order to facilitate multiple CDS requests coming from different healthcare settings. This architecture aims to aid users at different levels of Healthcare Delivery Organizations (HCOs) to maintain a CDS repository, along with monitoring and managing services, thus enabling transparency. The research employs the Design Science research methodology (DSRM) combined with The Open Group Architecture Framework (TOGAF), an open source group initiative for Enterprise Architecture Framework (EAF). DSRM’s iterative capability addresses the rapidly evolving nature of workflows in healthcare. This SOA based solution uses standards-based open source technologies and platforms, the latest healthcare standards by HL7 and OMG, Decision Support Service (DSS) and Retrieve, Update Locate Service (RLUS) standard. Combining business process management (BPM) technologies, business rules with SOA ensures the HCO’s capability to manage its processes. This architectural solution is evaluated by successfully implementing evidence based CGs at the point of care in areas such as; a) Diagnostics (Chronic Obstructive Disease), b) Urgent Referral (Lung Cancer), c) Genome testing and integration with CDS in screening (Lynch’s syndrome). In addition to medical care, the CDS solution can benefit organizational processes for collaborative care delivery by connecting patients, physicians and other associated members. This framework facilitates integration of different types of CDS ideal for the different healthcare processes, enabling sharable CDS capabilities within and across organizations

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

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.

Health ManagementInformation Systems for Resource Allocation and Purchasing in Developing Countries

World Bank, Health Nutrition and Population, Discussion Paper: The paper begins with the premise that it is not possible to implement an efficient, modern RAP strategy today without the effective use of information technology. The paper then leads the architect through the functionality of the systems components and environment needed to support RAP, pausing to justify them at each step. The paper can be used as a long-term guide through the systems development process as it is not necessary (and likely not possible) to implement all functions at once. The paper’s intended audience is those members of a planning and strategy body, working in conjunction with technical experts, who are charged with designing and implementing a RAP strategy in a developing country

Behavior change techniques to promote healthcare professionals' eHealth competency : A systematic review of interventions

Introduction: The use of eHealth is rapidly ->increasing; however, many healthcare professionals have insufficient eHealth competency. Consequently, interventions addressing eHealth competency might be useful in fostering the effective use of eHealth. Objective: Our systematic review aimed to identify and evaluate the behavior change techniques applied in interventions to promote healthcare professionals' eHealth competency. Methods: We conducted a systematic literature review following the Joanna Briggs Institute's Manual for Evidence Synthesis. Published quantitative studies were identified through screening PubMed, Embase, and CINAHL. Two reviewers independently performed full-text and quality assessment. Eligible interventions were targeted to any healthcare professional and aimed at promoting eHealth capability or motivation. We synthesized the interventions narratively using the Behavior Change Technique Taxonomy v1 and the COM-B model. Results: This review included 32 studies reporting 34 heterogeneous interventions that incorporated 29 different behavior change techniques. The interventions were most likely to improve the capability to use eHealth and less likely to enhance motivation toward using eHealth. The promising techniques to promote both capability and motivation were action planning and participatory approach. Information about colleagues' approval, emotional social support, monitoring emotions, restructuring or adding objects to the environment, and credible source are techniques worth further investigation. Conclusions: We found that interventions tended to focus on promoting capability, although motivation would be as crucial for competent eHealth performance. Our findings indicated that empathy, encouragement, and usercentered changes in the work environment could improve eHealth competency as a whole. Evidence-based techniques should be favored in the development of interventions, and further intervention research should focus on nurses and multifaceted competency required for using different eHealth systems and devices.Peer reviewe

An empirical assessment of patient healthcare quality: A lean hospital supply chain perspective

Improving the quality of healthcare services available to patients and increasing the efficiency of treatment processes are two pressing needs of the U.S. healthcare system. Aside from extensive research on medicine and disease-specific cures, extant literature does not offer a comprehensive framework that considers all determinants of patient care quality. The objective of this research is to offer an empirically tested framework that may be used by full-service U.S. hospitals to improve the quality of care available to their admitted patients. This framework draws in variables from both external as well as internal hospital supply chains, as recommended by many healthcare experts, and uses lean principles as the basic underlying philosophy thereby filling the aforementioned gap in the literature. To test the hypotheses a cross-sectional online survey was conducted resulting in responses from 294 senior hospital executives located all over the U.S. Structural equation modeling using LISREL 8.53 software was used to analyze the data. The results of the study demonstrate empirical support for all the suggested hypotheses. This research contributes to operations and healthcare literature. First, a unified supply chain framework is offered that integrated several constructs which have been mentioned in a piecemeal manner across several studies in healthcare, operations and medical fields. Second, the results of this study highlight the need for academicians to comprehensively measure patient care quality (PCQ). Typically, three dimensions of PCQ--interpersonal, environmental and administrative quality--are overlooked in the operations and healthcare literature. Third, hospitals need to effectively manage relationships with their suppliers because lean practices cannot be implemented without active supplier and cooperation. Finally, this research provides empirically tested measures for PCQ which are more comprehensive than those available in extant literature. The framework has implications for healthcare practice as well. Patients in hospitals would benefit from an integration of the entities of the hospital supply chains because the healthcare system would then focus on the effectiveness and efficiency of all elements and their individual processes. Full-service hospitals across the U.S. may find the framework useful in their efforts to improve the quality of admitted patient care

Improvement of outpatient service processes based on BRP theory and information technology: a case study of the University of Hong Kong-Shenzhen Hospital

JEL Classification: M15 – IT Management, I12 – Health ProductionCurrently, due to some irrational allocation of medical and healthcare resources, a considerable proportion of state-of-the-art medical equipment and talented medical personnel are concentrated in large urban hospitals. This situation is particularly common in 3A hospitals (3A hospitals are hospitals which are equipped with more than 501 beds, can provide medical and healthcare services with high-level specialty to various regions and with scores higher than 900 according to the grading standard), which are often crowded with patients. According to the normal outpatient process, patients need to undergo a prolonged procedure from registration, treatment, laboratory test, diagnosis to drug dispensing. Often patients have to spend a long time waiting for treatment, receiving tests and paying for medical care. The congestion of patients at certain time-consuming processes allows doctors little time to check and treat patients thoroughly. As a result, doctors are often unable to make accurate and comprehensive diagnosis. Considered the window of a hospital, outpatient service is extremely important. Whether the design of its process is reasonable and whether its management is able to maximize interests for patients will directly affect the hospital’s medical level, and even its social benefits and reputation. Therefore, it has become a major issue for a hospital achieves to optimize the business process of its outpatient service. Outpatient process, as a core business process of a hospital, is critical to improving the quality of its medical service, upgrading its performance and minimizing its operating costs. Therefore, re-designing the outpatient process of a hospital can help enhance its comprehensive strength by endowing it with a core competence. In addition, the hospital will be impelled to provide patients with more convenient medical services with higher quality and lower price. This work conducts a case study on The University of Hong Kong-Shenzhen Hospital (HKU-SZH), which was the first to implement an outpatient appointment registration system. This thesis gives an anatomy of the outpatient process of the hospital through various methods and theories, such as literature review, field research, expert consultation, Business Process Reengineering Theory and Information technology, aiming to identify objectives and strategies of the case hospital in improving its outpatient process. The study consists of: - An investigation into the current situation of HKU-SZH’s outpatient registration process: through questionnaires and structured interviews, the defects and weak links in the hospital’s appointment registration model were analyzed. A structural equation model for existing outpatient processes was established and the influence of different variables on patients’ satisfaction level as well as the correlation between these variables was analyzed by means of a simulation model. - Research on outpatient process reengineering: with the needs and satisfaction of patients as a goal, this thesis reexamines the strategic goals and internal and external environment of HKU-SZH on the basis of Business Process Reengineering Theory, Queuing Theory, Six Sigma Theory and Information technology. This thesis improves HKU-SZH’s registration process, using methods of order modification, integration, simplification and automation and materializes the process by network technology and outpatient information system. - An empirical study on outpatient process: this thesis conducts a systemic and empirical analysis in a functional integration of registration and payment, process reengineering research through information technology (development of new functions of appointment system) and an empirical study on queuing theory. - Research on local adaptation of outpatient process: this thesis explores solutions and suggestions for HKU-SZH with the objective of optimize its outpatient process through the perspectives of hospital organizational structure, information technology, human resources, building of outpatient culture and optimization of waiting cost. By means of outpatient process reengineering, this thesis aim to increase the case hospital’s efficiency and raise its patients’ satisfaction so that the hospital may enhance its comprehensive competence. In addition, an effective and operable methodology will be generated, which is expected to serve as a reference for other hospitals to improve their operation and their management.Atualmente, devido a alguma atribuição irracional dos recursos médicos e de saúde, uma proporção considerável de modernos equipamentos médicos e pessoal médico talentoso estão concentrados em grandes hospitais urbanos. Esta situação é particularmente comum em hospitais 3A (hospitais 3A são os hospitais que estão equipados com mais de 501 camas, e que podem fornecer serviços médicos e de saúde com alto nível de especialidade para diversas regiões e com pontuações superiores a 900 de acordo com o padrão de classificação), que são frequentemente sobrelotados com pacientes. De acordo com o processo ambulatório normal, os pacientes precisam passar por um procedimento prolongado desde o registo, tratamento, análise laboratorial, diagnóstico, até à distribuição de medicamentos. Muitas vezes os pacientes têm de passar um longo tempo de espera para tratamento, para receber testes e para pagar por cuidados médicos. O congestionamento de pacientes em determinados processos demorados, leva a que os médicos tenham pouco tempo para verificar e tratar os pacientes completamente. Como resultado, os médicos são muitas vezes incapazes de fazer um diagnóstico preciso e abrangente. Considerado a montra de um hospital, o serviço ambulatório é extremamente importante. Se o desenho do seu processo é razoável e se a sua gestão é capaz de maximizar os interesses dos pacientes, irá afetar diretamente o nível médico do hospital, e até mesmo os seus benefícios sociais e reputação. Portanto, tornou-se um importante problema para um hospital conseguir otimizar o processo do seu serviço ambulatório. O processo ambulatório, como um processo de negócio nuclear de um hospital, é fundamental para melhorar a qualidade do seu serviço médico, aumentar o seu desempenho e minimizar seus custos operacionais. Portanto, reprojetar o processo ambulatório de um hospital pode ajudar a aumentar a sua força global dotando-o de uma competência essencial. Além disso, o hospital será impelido a oferecer aos pacientes serviços médicos mais convenientes com maior qualidade e menor preço. Este trabalho apresenta um estudo de caso sobre o Hospital da Universidade de Hong Kong-Shenzhen (HKU-SZH), que foi o primeiro a implementar um sistema de registo de consulta externa. Esta tese apresenta uma análise do processo ambulatório do hospital através de vários métodos e teorias, como a revisão de literatura, pesquisa de campo, consultas a especialistas, teoria da reengenharia de processos e tecnologias da informação, com o objetivo de identificar os objetivos e estratégias do hospital na melhoria do seu serviço ambulatório. O estudo consiste em: - Investigação sobre a situação atual do processo de registo ambulatório de HKU-SZH. Através de questionários e entrevistas estruturadas, foram analisados os defeitos e pontos fracos no modelo de registro de consultas do hospital. Um modelo de equações estruturais para os processos ambulatórios existentes foi estabelecido, e a influência de diferentes variáveis sobre o nível de satisfação dos pacientes, bem como a correlação entre essas variáveis foi analisada por meio de um modelo de simulação. - Investigação sobre a reengenharia do processo ambulatório. Tendo as necessidades e satisfação dos pacientes como objetivo, esta tese reexamina as metas estratégicas e o ambiente interno e externo de HKU-SZH com base na Teoria da Reengenharia de Processos, Teoria das Filas, Teoria Six Sigmae Tecnologias da Informação. Esta tese melhora o processo de registro de HKU-SZH, usando métodos de modificação, integração, simplificação e automação e materializa o processo através de tecnologias de rede e um sistema de informação para o processo ambulatório. - Estudo empírico sobre o processo ambulatório. Esta tese conduz uma análise sistémica e empírica sobre a integração funcional de inscrições e pagamentos, a pesquisa de reengenharia de processos através de tecnologias da informação (desenvolvimento de novas funções do sistema de consultas) e um estudo empírico sobre a teoria das filas. - Investigação sobre a adaptação local do processo ambulatório. Esta tese explora soluções e sugestões para o HKU-SZH para otimizar seu processo ambulatório através das perspetivas de estrutura hospitalar organizacional, tecnologias da informação, recursos humanos, construção da cultura do ambulatório e otimização do custo de espera. Por meio do processo de reengenharia do serviço de ambulatório, esta tese visa aumentar a eficiência do processo de internamento e aumentar a satisfação dos seus pacientes para que o hospital possa aumentar a sua capacidade global. Além disso, foi gerada uma metodologia eficiente e operacionalizavel, a qual se espera possa servir como referência para outros hospitais, para melhorar o seu funcionamento e a sua gestão