And the Keyboard Goes Click, Click, Click

In this essay I discuss the use of Electronic Health Records (EHRs) from three different points of view. These perspectives come from my experiences as a patient, family physician, and medical anthropologist. I briefly explore how health care practitioners repeatedly have been told that EHRs hold great promise to facilitate communication with patients. I note how EHRs have, at present, far from reached that promise: in general, health care practitioners have yet to integrate EHRs in ways that promote a shared therapeutic presence—the healing human connection that can emerge in clinical encounters—between them and their patients. I conclude by examining my own limitations in using the EHR and the mindful lesson I have learned in the process

adobe medicus 2015 3 May-June

https://digitalrepository.unm.edu/adobe-medicus/1081/thumbnail.jp

Information Needs and Requirements for Decision Support in Primary Care: An Analysis of Chronic Pain Care

Decision support system designs often do not align with the information environments in which clinicians work. These work environments may increase Clinicians’ cognitive workload and harm their decision making. The objective of this study was to identify information needs and decision support requirements for assessing, diagnosing, and treating chronic noncancer pain in primary care. We conducted a qualitative study involving 30 interviews with 10 primary care clinicians and a subsequent multidisciplinary systems design workshop. Our analysis identified four key decision requirements, eight clinical information needs, and four decision support design seeds. Our findings indicate that clinicians caring for chronic pain need decision support that aggregates many disparate information elements and helps them navigate and contextualize that information. By attending to the needs identified in this study, decision support designers may improve Clinicians’ efficiency, reduce mental workload, and positively affect patient care quality and outcomes

The Effect of EHR-Integrated Patient Reported Outcomes on Satisfaction with Chronic Pain Care

Objective Given its complexity, chronic noncancer pain presents an opportunity to use health information technology (IT) to improve care experiences. The objective of this study was to assess whether integrating patient-reported outcomes (PRO) data in an electronic health record (EHR) affects providers and patient satisfaction with chronic noncancer pain care. Study Design We conducted a pragmatic cluster randomized trial involving four family medicine clinics. Methods We enrolled primary care providers (PCPs) and their patients with chronic noncancer pain. In the first seven months (education phase), PCPs in intervention practices received education on how to use PROs for pain care. In the second seven months (PRO phase), patients in intervention practices reported pain-related outcomes upon arrival at their visits. PROs were immediately reported to PCPs through the EHR. Control group PCPs provided usual care. We compared intervention and control practices in terms of provider and patient satisfaction with care. Results During the education phase, patients’ mean ratings of their visits did not differ between control and intervention (9.33 vs. 9.08, p=0.20). During the PRO phase, patients’ mean ratings did not differ between control and intervention (9.28 vs 9.01, p=0.20). Similarly, there were no differences between the intervention and control groups in terms of provider satisfaction. Conclusion Delivering EHR-integrated PROs did not consistently improve patient or provider satisfaction. Positively, we found no evidence that the PRO tools negatively affected satisfaction. Future studies and technological innovations are needed to translate point-of-care health IT tools to improvements in patient and provider experiences

Consumer Health Informatics: Empowering Healthy-Lifestyle-Seekers Through mHealth

People are at risk from noncommunicable diseases (NCD) and poor health habits, with interventions like medications and surgery carrying further risk of adverse effects. This paper addresses ways people are increasingly moving to healthy living medicine (HLM) to mitigate such health threats. HLM-seekers increasingly leverage mobile technologies that enable control of personal health information, collaboration with clinicians/other agents to establish healthy living practices. For example, outcomes from consumer health informatics research include empowering users to take charge of their health through active participation in decision-making about healthcare delivery. Because the success of health technology depends on its alignment/integration with a person's sociotechnical system, we introduce SEIPS 2.0 as a useful conceptual model and analytic tool. SEIPS 2.0 approaches human work (i.e., life's effortful activities) within the complexity of the design and implementation of mHealth technologies and their potential to emerge as consumer-facing NLM products that support NCDs like diabetes

What Makes Health Data Privacy Calculus Unique? Separating Probability from Impact

Patient health data is heavily regulated and sensitive. Patients will sometimes falsify data to avoid embarrassment resulting in misdiagnoses and even death. Existing research to explain this phenomenon is scarce with little more than attitudes and intents modeled. Similarly, health data disclosure research has only applied existing theories with additional constructs for the healthcare context. We argue that health data has a fundamentally different cost/benefit calculus than the non-health contexts of traditional privacy research. By separating the probability of disclosure risks and benefits from the impact of that disclosure, it is easier to understand and interpret health data disclosure. In a study of 1590 patients disclosing health information electronically, we find that the benefits of disclosure are more difficult to conceptualize than the impact of the risk. We validate this using both a stated and objective (mouse tracking) measure of patient lying

The Promise of Information and Communication Technology In Health Care: Extracting Value from the Chaos

Healthcare is an information business with expanding use of information and communication technologies (ICTs). Current ICT tools are immature, but a brighter future looms. We examine 7 areas of ICT in healthcare: electronic health records (EHRs), health information exchange (HIE), patient portals, telemedicine, social media, mobile devices and wearable sensors and monitors, and privacy and security. In each of these areas, we examine the current status and future promise, highlighting how each might reach its promise. Steps to better EHRs include a universal programming interface, universal patient identifiers, improved documentation and improved data analysis. HIEs require federal subsidies for sustainability and support from EHR vendors, targeting seamless sharing of EHR data. Patient portals must bring patients into the EHR with better design and training, greater provider engagement and leveraging HIEs. Telemedicine needs sustainable payment models, clear rules of engagement, quality measures and monitoring. Social media needs consensus on rules of engagement for providers, better data mining tools and approaches to counter disinformation. Mobile and wearable devices benefit from a universal programming interface, improved infrastructure, more rigorous research and integration with EHRs and HIEs. Laws for privacy and security need updating to match current technologies, and data stewards should share information on breaches and standardize best practices. ICT tools are evolving quickly in healthcare and require a rational and well-funded national agenda for development, use and assessment

An Institutional Theory Perspective on EHR Engagement: Mandates, Penalties, and Enforcement

Electronic Health Record (EHR) systems are the predominant information system (IS) used by healthcare clinicians and have been the source of both great success and pain. User engagement with EHR systems is unique from traditional IS contexts in significant ways. Prior research explains EHR usage and success primarily on traditional technology acceptance research (i.e., TAM, UTAUT). However, these models assume that EHR engagement is no different from IS systems in general business domains. Yet, the healthcare context is far more regulated than most. Based on qualitative focus group sessions with a leading healthcare analytics firm (KLAS Research), we identify the role of mandates, penalties, and enforcements from government, organizations, associations, and insurance companies in explaining EHR engagement. We validate a measurement instrument for these factors and demonstrate that their inclusion can improve model fit five times over a traditional UTAUT-based model (R2 = 54.8% versus 10.2%)

Interoperable EHR Systems – Challenges, Standards and Solutions

Background: Electronic Health Record Systems (EHRS) and Personal Health Record Systems (PHRS) are core components of infrastructure needed to run any health system. Objectives: As health systems undergo paradigm changes, EHRS and PHRS have to advance as well to meet the related interoperability challenges. Methods: The paper discusses EHR types, implementations and standards, starting with different requirements specifications, systems and systems architectures, standards and solutions. Results: Existing standards and specifications are compared with changing requirements, presenting weaknesses and defining the advancement of EHRS, architectures and related services, embedded in advanced infrastructure systems. Conclusion: Future EHR systems are components in a layered architecture with open interfaces. The need of verifying data models at business domains level is specifically highlighted. Such approach is enabled by the ISO Interoperability Reference Architecture of a systemoriented, architecture-centric, ontology-based, policy- driven approach, meeting good modeling best practices

Thorny Roads of Scholarly Communication: An Evaluation on the Publication Process of Articles

Hazırlanma süreci oldukça zahmetli ve uzun süren makalelerin yayımlanma süreci de bir o kadar zaman alabilmektedir. Makalelerin yayımlanma süreci hem disiplinden disipline hem de aynı disiplin içinde dergiden dergiye farklılık gösterebilmektedir. Kimi araştırmacılar dergilerin yayımlama süreci ile ilgili bilgilere sahip olmadan makalelerini ilgili dergilere göndermekte ve zaman zaman sürecin uzunluğu konusunda sıkıntı yaşamaktadırlar. Her disiplindeki araştırmacıların kendi alanlarındaki dergilerin bilimsel iletişim sürecindeki tutumları ile ilgili bilgi sahibi olmasında yarar bulunmaktadır. Bu çalışmada bilgibilim dergilerindeki makale yayımlanma süreçleri incelenmektedir. Bu bağlamda araştırmamızda, “Bilgibilim alanındaki dergiler için makalelerin dergiye ulaştığı zaman ile yayımlandığı zaman arasında ne kadarlık bir süre geçmektedir? Bilgibilim alanındaki dergilerde makalelerin yayımlanma süresi dergiden dergiye farklılık göstermekte midir? Bilgibilim alanındaki makalelerin en hızlı şekilde yayımlandığı dergiler ve yayın süreci en uzun dergiler hangileridir?” sorularına yanıt aranmaya çalışılmaktadır. Çalışmamız kapsamında Journal Citation Reports (JCR)’ta yer alan bilgibilim dergileri içerisinden araştırma sorularımızın yanıtlarını verebilecek niteliğe sahip 30 dergiden 1939 makale incelenmiştir. Çalışmanın amacı doğrultusunda makalelerin geliş ve düzeltme, geliş ve kabul edilme, geliş ve yayımlanma, düzeltme ve kabul edilme, düzeltme ve yayımlanma ile kabul edilme ve yayımlanma süreleri arasında geçen zaman, gün cinsinden hesaplanmıştır. Bilgibilim makaleleri değerlendirildiğinde, geliş-düzeltme, düzeltme-kabul ve kabul-yayımlanma süreleri arasında en uzun sürenin makalelerin gelişi ile düzeltilmesi arasında geçtiği saptanmıştır. Bilgibilim dergilerine gönderilen makalelerin yayımlanma süreci ortalama olarak dokuz ay sürmektedir ve bu süre dergiden dergiye oldukça farklılık göstermektedir. Information Systems Research, Information Society, Information and Organization ve Information and Management gibi dergiler makale yayımlanma sürecinin en uzun sürdüğü dergiler arasında ön sıralarda yer alırken, Journal of Academic Librarianship, Scientometrics, Telematics and Informatics ve Journal of Informetrics gibi dergiler araştırmamız kapsamında incelenen dergiler arasında makalelerin en kısa sürede yayımlandığı dergilerdir. Makalelerin yayımlanma sürecinin uzaması birçok açıdan sorun yaratmaktadır. Konunun ilgililer tarafından dikkatli şekilde ele alınıp sorunlara yönelik olası çözüm yollarının tartışılması ve araştırılması gerekmektedir.Publication process of an article can be as tiresome and as long as its preparation process. Publication process of articles can vary not only among the disciplines but also according to the journals within the same discipline. Some researchers send their articles to journals without having knowledge about the publication process and face with problems due to the length of the process. It is advantageous for every researcher in every field to have knowledge about the attitude of the journals in their field during the scholarly communication process. In this study, article publication processes of information science journals have been examined. In this context, we tried to answer questions such as; what is the duration between the time that the articles are received and published in information science journals? Can the publication duration of articles differentiate between the information science journals? Which journals publish the fastest the articles in the field of information science and which journals have the longest publication process? Within the scope of our study, 1939 articles within 30 information science journals, which are parts of the Journal Citation Reports (JCR) and have the capacity to answer our research questions, have been examined. In the direction of the study’s purpose, elapsed time between the reception and revision, reception and acceptance, reception and publication, revision and acceptance, revision and publication, acceptance and publication of the articles have been calculated day-denominated. After the assessment of information science articles, it is found out that the longest time is between the reception-revision, compared to revision-acceptance and acceptance-publication. Publication process of the articles that are sent to information science journals last about nine months and this duration differentiate significantly according to journals. While the journals such as Information Systems Research, Information Society, Information and Organization, and Information and Management are among the ones that has the longest article publication process, Journal of Academic Librarianship, Scientometrics, Telematics and Informatics, and Journal of Informetrics are among the journals that have the fastest article publication process. Extension of the publication process of the articles brings several problems with itself. This problem should be taken into consideration carefully by the relevant people and possible solutions should be searched and discussed