The perception of primary health care's physicians in adoption of electronic health record-Timor Leste

Introduction: Electronic health record becomes the 21st-century innovation trend in developing countries. This digital system provides accurate, real data in real-time access, decreases paper-based documentation, enables access to patient’s previous health status and easy for follow-up, reduces of health status duplication and, allows accessible data sharing among health professionals in the primary health care setting. Purpose: This research aimed to identify and understand the perceptions of primary health care physicians in adopting the electronic health record in the Timor Leste context, specifically to identify benefit, barrier, and satisfaction of this system. Method: A cross-sectional online questionnaire survey was based on the study objectives administered to the medical doctor in primary health care level in Timor Leste who, received an electronic health record training and had an opportunity to utilize in the period between 2015 to 2017. The form was composed of 4 sections (sociodemographic information, benefit, barrier, and satisfaction), rated on a five-point Likert-scale. The samples were calculated by G*Power 3.1.9.4. The reliability was tested by Cronbach’s alpha. The statistical analysis with α= .05, CI= 95%. Result: The online questionnaire was distributed among 193 general physicians with, 84.5% responded rates. Most of the participants had young ages that acknowledge the importance of EHR in the primary health care sector. The majority perceived the most benefit of the EHR: decreased paper-based documentation, facilitated accessibility to patient data recorded previously, provided real-time data access, and reduction on health data duplication. However, barriers remain on the eHealth system indicated by a medical doctor, such as the necessity of frequent revision to technological development, compatibility of web browser, connectivity, and cost in adopting it. Overall, the physician in primary care settings perceived satisfaction toward the digital system. The eHealth was useful, appropriate, and essential for their work area, improved patient safety, elevated quality care, and enabled better communication among health professionals. There were statistically significant differences among ages toward benefit, the ability to use computer toward barrier and place using computer toward satisfaction of EHR usage. The positive slope of the benefit (β= .498; t= 11.361), had a statistically significant predictor on satisfaction on EHR implementation but barrier had negative statistical significance toward satisfaction (β = -.086; t= -1.794). The adjusted (R2= 51.0%). Conclusion: The satisfaction of EHR was influenced by the benefit perceived while utilizing the system and reducing the barrier. Political commitment, financial support, friendly user application, improved quality of internet connection and had a positive attitude toward EHR were crucial for successful implementation.open석

Transactions of 2015 International Conference on Health Information Technology Advancement Vol.3, No. 1

The Third International Conference on Health Information Technology Advancement Kalamazoo, Michigan, October 30-31, 2015 Conference Chair Bernard Han, Ph.D., HIT Pro Department of Business Information Systems Haworth College of Business Western Michigan University Kalamazoo, MI 49008 Transactions Editor Dr. Huei Lee, Professor Department of Computer Information Systems Eastern Michigan University Ypsilanti, MI 48197 Volume 3, No. 1 Hosted by The Center for Health Information Technology Advancement, WM

Effect of electronic health records on doctor-patient relationship in Arabian gulf countries: a systematic review

BackgroundThe electronic health record (EHR) has been widely implemented internationally as a tool to improve health and healthcare delivery. However, EHR implementation has been comparatively slow amongst hospitals in the Arabian Gulf countries. This gradual uptake may be linked to prevailing opinions amongst medical practitioners. Until now, no systematic review has been conducted to identify the impact of EHRs on doctor-patient relationships and attitudes in the Arabian Gulf countries.ObjectiveTo understand the impact of EHR use on patient-doctor relationships and communication in the Arabian Gulf countries.DesignA systematic review of English language publications was performed using PRISMA chart guidelines between 1990 and 2023.MethodsElectronic database search (Ovid MEDLINE, Global Health, HMIC, EMRIM, and PsycINFO) and reference searching restricted to the six Arabian Gulf countries only. MeSH terms and keywords related to electronic health records, doctor-patient communication, and relationship were used. Newcastle-Ottawa Scale (NOS) quality assessment was performed.Results18 studies fulfilled the criteria to be included in the systematic review. They were published between 1992 and 2023. Overall, a positive impact of EHR uptake was reported within the Gulf countries studied. This included improvement in the quality and performance of physicians, as well as improved accuracy in monitoring patient health. On the other hand, a notable negative impact was a general perception of physician attention shifted away from the patients themselves and towards data entry tasks (e.g., details of the patients and their education at the time of the consultation).ConclusionThe implementation of EHR systems is beneficial for effective care delivery by doctors in Gulf countries despite some patients' perception of decreased attention. The use of EHR assists doctors with recording patient details, including medication and treatment procedures, as well as their outcomes. Based on this study, the authors conclude that widespread EHR implementation is highly recommended, yet specific training should be provided, and the subsequent effect on adoption rates by all users must be evaluated (particularly physicians). The COVID-19 Pandemic showed the great value of EHR in accessing information and consulting patients remotely

Hospital utilization in chronic spinal injury and primary physicians' adherence to clinical guidelines: three approaches to answering health services questions

Thesis (Sc.D.)--Boston UniversityThe first study was a prospective observation of predictors of cardiopulmonary hospitalization in a cohort of spinal cord injury (SCI) patients at Veterans Affairs (VA) centers at least one year post-SCI. Baseline data were linked to longitudinal 1996-2003 VA hospitalization data. Predictors of admission with circulatory or respiratory system illness, the outcome, were assessed by multivariate Cox regression. 143 cardiopulmonary hospitalizations were observed. Independent predictors were greater age (3% increase/year), hypertension, lowest body mass index (BMI) quintile (<22.4kg/m^2), and reduced lung function. SCI severity / neurological level did not significantly predict the outcome independent of covariates. Cardiopulmonary hospitalization risk in chronic SCI is related to greater age and medical factors that could result in strategies for reducing such hospitalizations. The second study investigated factors associated with risk-adjusted length of stay (LOS) for VA and Medicare-reimbursed hospitalizations prospectively observed in the same cohort. We merged 1999-2003 admissions in the Medicare Provider Analysis and Review (MEDPAR) dataset with the 1996-2003 VA hospitalizations. Risk-adjusted LOS was assessed in a multivariable Gaussian identity-linked generalized estimating equation (GEE) adjusting for repeated events. Unadjusted median LOS was 6 days for Medicare versus 8 days for the VA. Adjusting for repeated events and geographical location, LOS was significantly associated with ICU days, SCI severity, comorbidities, and surgical procedures. Risk-adjusted LOS did not differ between the Medicare and VA. Reducing LOS across both healthcare systems requires alleviating illness burden, lessening comorbidity, preventing skin ulcers, increasing mobility, and decreasing inpatient procedures. The third study was a cross-sectional observation of managed care attitudes and adherence to evidence-based clinical guidelines among primary care physicians (PCPs) enrolled in a pay-for-performance (P4P) collaboration. Participants were 186 survey respondents with complete adherence data for a panel-representative medical condition targeted by P4P incentives. Guideline adherence, defined as the percent of recommended services actually delivered, was the outcome. Provider attitudes that were significantly associated with top-tertile adherence, independent of specialty and prior behavior, were financial salience, peer cooperation, control, and autonomy. The most adherent PCPs found the P4P incentives salient and felt peer-supported, but high-autonomy providers found early-stage incentives intrinsically demoralizing and they reduced work effort

Comparison of the effectiveness of traditional nursing medication administration with the Color Coding Kids system in a sample of undergraduate nursing students

The problem of medication errors in hospitals and the vulnerability of pediatric patients to adverse drug events (ADE) was investigated and well substantiated. The estimated additional cost of inpatient care for ADE’s in the hospital setting alone was conservatively estimated at an annual rate per incident of 400,000 preventable events each incurring an extra cost of approximately $5,857. The purpose of the researcher was to compare the effectiveness of traditional nursing medication administration with the Color Coding Kids (CCK) system (developed by Broselow and Luten for standardizing dosages) to reduce pediatric medication errors. A simulated pediatric rapid response scenario was used in a randomized clinical study to measure the effects of the CCK system to the traditional method of treatment using last semester nursing students. Safe medication administration, workflow turnaround time and hand-off communication were variables studied. A multivariate analysis of variance was used to reveal a significant difference between the groups on safe medication administration. No significant difference between the groups on time and communication was found. The researcher provides substantial evidence that the CCK system of medication administration is a promising technological breakthrough in the prevention of pediatric medication errors

Perception gaps and the adoption of information technology in the clinical healthcare environment

Implementation of information systems has lagged in many areas of clinical healthcare for a variety of reasons. Economics, data complexity and resistance are among the often quoted roadblocks. Research suggests that physicians play a major part in the adoption, use and diffusion of information technology (IT) in clinical settings. There are also other healthcare professionals, clinical and non-clinical, who play important roles in making decisions about the acquisition of information technology. In addition to these groups there are information technology professionals providing the services required within the healthcare field. Finally within this group are those IT professionals who have sufficient cross training to understand specific needs. Each member of these groups brings a different perspective to both needs assessments as well as implementation of clinical systems. This study considers the idea that there are preconceived differences of opinion of the information needs of clinical healthcare by the clinical community and the information technology professionals. Are these differences significant enough to create a barrier to implementation? A questionnaire was developed from preliminary data to assess multiple parameters which could impact implementation of a clinical information technology solution. A Web of System Performance (WOSP) model was created to map each of the following eight areas of concern: functionality, usability, extendibility, connectivity, flexibility, reliability, privacy and security. Responses to the questions were related to professional roles, age and experience. There were no differences seen in the perceived need for secure systems by either healthcare workers or IT professionals. The variance of perceived need was greatest among the various non-physician healthcare workers when compared to physicians or information technology professions. This was a consistent pattern for the otherparameters with the exception of the usability of the electronic health record. In this area all groups disagreed significantly. The study, though limited by its small sample, still suggests that the resistance by healthcare professionals is not a significant barrier to successful information technology implementation

The Use of a Mobile-Based Telehealth Service During the COVID-19 Pandemic: Provider Experience and Satisfaction

Background: Telehealth is a promising healthcare delivery model that uses telecommunication technologies to improve healthcare access by remotely offering health care services to people with limited access to these services. Due to the lockdown and restrictions caused by the COVID-19 pandemic, many healthcare organizations are now utilizing telehealth systems to remotely provide health care services and mitigate the spread of COVID-19 by minimizing physical interactions. Objective: To assess the providers’ experience and satisfaction with a telehealth technology “Sehha” being used by physicians during COVID-19, examine the challenges faced by the providers, and identify possible opportunities to improve the use of telehealth in Saudi Arabia. Method: With the collaboration of the Saudi Ministry of Health, a 30-item questionnaire consisting of quantitative and qualitative questions was distributed to 362 physicians using the Sehha telehealth app. The questionnaire items were adapted from previous studies and then tested for content validity and reliability (α = 0.88). Results: One hundred fourteen out of 362 questionnaires were analyzed with a response rate of 31%. The study showed that 67.6% of the physicians were satisfied with the work they have done through Sehha. Forty-four percent of the physicians preferred telehealth visits over traditional visits, while 35.1% did not prefer telehealth, and 21.1% reported to be neutral. However, the most commonly perceived challenge by the physicians using Sehha was difficulty in providing accurate medical assessments (73.7%), followed by overlapping of consultations (71.1%), while the most frequently cited area of the platform needed for improvement was integration with other systems (86.8%), followed by involvement of other medical specialists (81.6%). Conclusion: Telehealth is the new norm of delivering health care service, and its benefits have been realized worldwide. Telehealth can increase access to care, improve the quality of care, and reduce cost. Besides face-to-face visits, health care providers are now embracing telehealth technologies and showing interest in virtual care. Thus, telehealth should remain sustained after the era of COVID-19, and healthcare leaders should reconsider the status of telehealth

Primary health care physicians’ perception of electronic health records adoption in Timor-Leste: a cross-sectional study

Background This study aimed to identify the factors affecting the successful operation of electronic health records (EHRs) during the initial pilot implementation period from 2015 to 2017. The EHR system in Timor-Leste was first launched in 2015 after the VI Constitutional Government introduced the “Saúde na Familia” initiative. In January 2019, the system was discontinued after being disrupted by a political impasse between 2017 and 2018. The new Minister of Health reactivated the adoption of the EHR system as of August 2020. Methods This study included a cross-sectional survey. The questionnaire covered benefits, barriers, and satisfaction categories along with sociodemographic variables. Results Statistically significant differences between age groups were noted for the benefits, perceived barriers (such as the ability to use computers), and overall satisfaction of the EHR system. The slope of the benefit category (β = 0.497, t = 11.361) was a statistically significant predictor of satisfaction with EHR system implementation. However, the slope of the barrier category had a negative statistical significance for satisfaction (β = −0.086, t = −1.794). Satisfaction with the EHR system was influenced by its perceived benefit and reduced perceived barriers due to individuals’ utilization of the information and communication technology system. Conclusion Continuous political commitment to health policy, financial support, friendly end-user applications, improved quality of Internet service, and a positive attitude toward the system were crucial for its successful implementation.ope

Patient Safety in Pediatrics: a Developing Discipline

__Abstract__ The publication of the breakthrough report “To Err is Human” by the Institute of Medicine was the launch of patient safety initiatives all over the world. In the intensive care unit (ICU) of the Erasmus MC-Sophia Children’s Hospital this resulted in the institution of a multimodal patient safety management system under the name Safety First in 2005. This system now includes nine major elements, representing monitoring and intervention activities. In this thesis we report on the results and the implementation of the patient safety management system called Safety First. __Outline of this thesis:__ In part I the concept of patient safety and the Safety First project are introduced. The rationale for selecting the elements of the patient safety management system is explained. As preventable mortality and morbidity are the public focus as outcome parameters for quality and safety of care, we have studied very long stay patients in our ICU (chapter 2). The goal of this study was to determine characteristics and mortality in these patients as well as modes of death. Chapter 3 presents an evaluation of potentially preventable deaths in our ICU. An important question was whether five years of patient safety efforts had resulted in fewer potentially preventable deaths. Part II reflects on the difficulties in monitoring adverse events. In chapter 4 we present numbers and types of adverse events identified with real time physicians’ registration during a 3-month period in general pediatric practice. The next chapter is a study into adverse events in the surgical pediatric ICU in a 2-year period. We combined the physicians’ registration with the Trigger Tool methodology as developed by the Institute for Healthcare, Boston, USA. The goals were to determine the rate and nature of the adverse events and to compare the two methods. In part III a number of elements of Safety First are described, as well as other studies into patient safety issues relevant to bedside ICU care. Chapter 6 brings the results of critical incident analysis with a focus on the factors contributing to the incident and the resultant recommendations. The next study evaluated the availability and reliability of drug formularies used in our ICU, which are crucial in safe drug prescription. In chapter 8 we discuss the safety of routine MRI scans in preterm infants at 30 weeks gestational age, as reflected by safety incidents and adverse events. In the next chapter, safety focused Mortality and Morbidity conference reports were scrutinized for numbers and types of recommendations stemming from these meetings. Chapter 10 is a study about nursing protocol violations established with the Critical Nursing Situation Index. Part IV describes a study of safety culture in the ICU, as it emerged from a safety attitude questionnaire administered to all staff. We aimed to compare findings to benchmark data and explore any deficiencies. In the general discussion in part V the results of the studies are commented on and future directions are given, including guidelines for optimal implementation of a patient safety management system and future benchmarking

Case study: evaluating performance outcomes of a technology change management initiative in a health care organization

The purpose of this research was to examine a case study by evaluating performance outcomes of a technology change management initiative in a health care organization. This study was developed with an array of issues surrounding change management programs with technology platforms, the management of complex change and the amount of criticism that became the impetus behind the implementation of the Electronic Health Records Management Systems (EHRMS) across the healthcare industry and its long-term transformative effects. Despite recognition that user response largely determined the success of a technology implementation or change management program and the fact significant resources are spent on strategic programs to promote acceptance, there was very little research in terms of evaluating performance outcomes which make a change management program more successful in health care settings. The study was challenging and the findings were inconclusive for the research questions. However, the qualitative data gathered from the comments/recommendations section of the eCare Research Survey provided additional information in great detail concerning the research topic. The capture of detailed opinions, attitudes, beliefs and comments/recommendations expressed by the respondents provided suggestions for revisions of the eCare change management program. This qualitative data also provided implications for future research in the field of change management