Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training.

Health information technology (HIT) is increasingly adopted by nursing homes to improve safety, quality of care, and staff productivity. We examined processes of HIT implementation in nursing homes, impact on the nursing home workforce, and related evidence on quality of care. We conducted a literature review that yielded 46 research articles on nursing homes' implementation of HIT. To provide additional contemporary context to our findings from the literature review, we also conducted semistructured interviews and small focus groups of nursing home staff (n = 15) in the United States. We found that nursing homes often do not employ a systematic process for HIT implementation, lack necessary technology support and infrastructure such as wireless connectivity, and underinvest in staff training, both for current and new hires. We found mixed evidence on whether HIT affects staff productivity and no evidence that HIT increases staff turnover. We found modest evidence that HIT may foster teamwork and communication. We found no evidence that the impact of HIT on staff or workflows improves quality of care or resident health outcomes. Without initial investment in implementation and training of their workforce, nursing homes are unlikely to realize potential HIT-related gains in productivity and quality of care. Policy makers should consider creating greater incentives for preparation, infrastructure, and training, with greater engagement of nursing home staff in design and implementation

Consolidated List of Requirements

This document is a consolidated catalogue of requirements for the Electronic Health Care Record (EHCR) and Electronic Health Care Record Architecture (EHCRA), gleaned largely from work done in the EU Framework III and IV programmes and CEN, but also including input from other sources including world-wide standardisation initiatives. The document brings together the relevant work done into a classified inventory of requirements to inform the on-going standardisation process as well as act as a guide to future implementation of EHCRA-based systems. It is meant as a contribution both to understanding of the standard and to the work that is being considered to improve the standard. Major features include the classification into issues affecting the Health Care Record, the EHCR, EHCR processing, EHCR interchange and the sharing of health care information and EHCR systems. The principal information sources are described briefly. It is offered as documentation that is complementary to the four documents of the ENV 13606 Parts I-IV produced by CEN Pts 26,27,28,29. The requirements identified and classified in this deliverable are referenced in other deliverables

Equity in the Digital Age: How Health Information Technology Can Reduce Disparities

While enormous medical and technological advancements have been made over the last century, it is only very recently that there have been similar rates of development in the field of health information technology (HIT).This report examines some of the advancements in HIT and its potential to shape the future health care experiences of consumers. Combined with better data collection, HIT offers signi?cant opportunities to improve access to care, enhance health care quality, and create targeted strategies that help promote health equity. We must also keep in mind that technology gaps exist, particularly among communities of color, immigrants, and people who do not speak English well. HIT implementation must be done in a manner that responds to the needs of all populations to make sure that it enhances access, facilitates enrollment, and improves quality in a way that does not exacerbate existing health disparities for the most marginalized and underserved

Decision aids can support cancer clinical trials decisions: Results of a randomized trial

BACKGROUND. Cancer patients often do not make informed decisions regarding clinical trial participation. This study evaluated whether a web-based decision aid (DA) could support trial decisions compared with our cancer center’s website. METHODS. Adults diagnosed with cancer in the past 6 months who had not previously participated in a cancer clinical trial were eligible. Participants were randomized to view the DA or our cancer center’s website (enhanced usual care [UC]). Controlling for whether participants had heard of cancer clinical trials and educational attainment, multivariable linear regression examined group on knowledge, self-efficacy for finding trial information, decisional conflict (values clarity and uncertainty), intent to participate, decision readiness, and trial perceptions. RESULTS. Two hundred patients (86%) consented between May 2014 and April 2015. One hundred were randomized to each group. Surveys were completed by 87 in the DA group and 90 in the UC group. DA group participants reported clearer values regarding trial participation than UC group participants reported (least squares [LS] mean = 15.8 vs. 32, p < .0001) and less uncertainty (LS mean = 24.3 vs. 36.4, p = .025). The DA group had higher objective knowledge than the UC group’s (LS mean = 69.8 vs. 55.8, p < .0001). There were no differences between groups in intent to participate. CONCLUSIONS. Improvements on key decision outcomes including knowledge, self-efficacy, certainty about choice, and values clarity among participants who viewed the DA suggest web-based DAs can support informed decisions about trial participation among cancer patients facing this preference-sensitive choice. Although better informing patients before trial participation could improve retention, more work is needed to examine DA impact on enrollment and retention. IMPLICATIONS FOR PRACTICE: This paper describes evidence regarding a decision tool to support patients’ decisions about trial participation. By improving knowledge, helping patients clarify preferences for participation, and facilitating conversations about trials, decision aids could lead to decisions about participation that better match patients’ preferences, promoting patient-centered care and the ethical conduct of clinical research

Pragmatic trials

No abstract available

A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties.

BackgroundThe U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis.DesignWe developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as "CDS opportunities," might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists' clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics

Linking Research and Policy: Assessing a Framework for Organic Agricultural Support in Ireland

This paper links social science research and agricultural policy through an analysis of support for organic agriculture and food. Globally, sales of organic food have experienced 20% annual increases for the past two decades, and represent the fastest growing segment of the grocery market. Although consumer interest has increased, farmers are not keeping up with demand. This is partly due to a lack of political support provided to farmers in their transition from conventional to organic production. Support policies vary by country and in some nations, such as the US, vary by state/province. There have been few attempts to document the types of support currently in place. This research draws on an existing Framework tool to investigate regionally specific and relevant policy support available to organic farmers in Ireland. This exploratory study develops a case study of Ireland within the framework of ten key categories of organic agricultural support: leadership, policy, research, technical support, financial support, marketing and promotion, education and information, consumer issues, inter-agency activities, and future developments. Data from the Irish Department of Agriculture, Fisheries and Food, the Irish Agriculture and Food Development Authority (Teagasc), and other governmental and semi-governmental agencies provide the basis for an assessment of support in each category. Assessments are based on the number of activities, availability of information to farmers, and attention from governmental personnel for each of the ten categories. This policy framework is a valuable tool for farmers, researchers, state agencies, and citizen groups seeking to document existing types of organic agricultural support and discover policy areas which deserve more attention