Information Technologies for the Healthcare Delivery System

That modern healthcare requires information technology to be efficient and fully effective is evident if one spends any time observing the delivery of institutional health care. Consider the observation of a practitioner of the discipline, David M. Eddy, MD, PhD, voiced in Clinical Decision Making, JAMA 263:1265-75, 1990, . . .All confirm what would be expected from common sense: The complexity of modern medicine exceeds the inherent limitations of the unaided human mind. The goal of this thesis is to identify the technological factors that are required to enable a fully sufficient application of information technology (IT) to the modern institutional practice of medicine. Perhaps the epitome of healthcare IT is the fully integrated, fully electronic patient medical record. Although, in 1991 the Institute of Medicine called for such a record to be standard technology by 2001, it has still not materialized. The author will argue that some of the technology and standards that are pre-requisite for this achievement have now arrived, while others are still evolving to fully sufficient levels. The paper will concentrate primarily on the health care system in the United States, although much of what is contained is applicable to a large degree, around the world. The paper will illustrate certain of these pre-requisite IT factors by discussing the actual installation of a major health care computer system at the University of Rochester Medical Center (URMC) in Rochester, New York. This system is a Picture Archiving and Communications System (PACS). As the name implies, PACS is a system of capturing health care images in digital format, storing them and communicating them to users throughout the enterprise

Data preparation for biomedical knowledge domain visualization: a probabilistic record linkage and information fusion approach to citation data

This thesis presents a methodology of data preparation with probabilistic record linkage and information fusion for improving and enriching information visualizations of biomedical citation data. The problem of record linkage of citation databases where only non-unique identifiers such as author names and document titles are available as common identifiers to be linked was investigated. This problem in citation data parallels problems in clinical data and Knowledge Discovery in Databases (KDD) methods from clinical data mining are evaluated. Probabilistic and deterministic (exact-match) record linkage models were developed and compared through the use of a gold standard or truth dataset. Empirical comparison with ROC analysis of record linkage models showed a significant difference (p=.000) in performance of a probabilistic model over deterministic models. The methodology was evaluated with probabilistic linkage of records from the Web of Science, Medline, and CINAHL citation databases in the knowledge domains of medical informatics, HIV/AIDS, and nursing informatics. Data quality metrics for datasets prepared with probabilistic record linkage and information fusion showed improvement in completeness of key variables and reduction in sample bias. The resulting visualizations offered a richer information space for users through an increase in terms entering the visualization. The significant contributions of this work include the development of a novel model of probabilistic record linkage for biomedical citation databases which improves upon existing deterministic models. In addition a methodology for improving and enriching knowledge domain visualizations though a data preparation approach has been validated with analyses of multiple citation databases and knowledge domains. The data preparation methodology of probabilistic record linkage with information fusion offers a remedy for data quality problems, and the opportunity to enrich visualizations with added content for user exploration, which in turn improves the utility of knowledge domain visualizations as a medium for assessing available evidence and forming hypotheses.Ph.D., Information Science -- Drexel University, 200

How collaborative the collaboration? : assessing the collaboration of services for juvenile offenders.

Juvenile delinquency with co-occurring substance abuse and mental health disorders has become an increasing problem within the United States. In part this can be attributed to the excessive number of delinquent youth entering the juvenile justice system with untreated substance abuse and/or mental health disorders-thus requiring juvenile justice to become a default system for substance abuse and mental health intervention and treatment services. In an effort to combat this problem, governmental, mental health, social support agencies, and school systems have formed interagency collaborations to provide more effective treatment services. One such interagency collaboration is the JETS Program, a court diversion program that provides intervention and treatment services for juvenile offenders with co-occurring substance abuse and mental health disorders. This study identifies the relationship between shared meaning and collaboration as well as the relationship between collaboration and goal achievement among the nine agencies involved in the JETS Program during the first year of the program\u27s inception. Utilizing a concurrent nested design and deductive content analysis, both qualitative and quantitative methodologies contributed to studying the phenomena of shared meaning and the impact that shared meaning can have on a juvenile interagency collaboration. In order to accomplish this task, 16 service providers (i.e., individuals who provide, or supervise the direct services to juveniles participating in the JETS Program) participated in semi-structured interviews and service provider surveys that focused on the individual\u27s perceptions of collaboration within the JETS Program partnership. Findings indicate that although the JETS Program partners had shared meaning around the appropriate professionals being involved with the program and the goal of the program, a lack of shared meaning on partner roles, referral processes, and overall program structure contributed to negative program outcomes and a general sense of frustration among the service providers

Public Trust in Health Information Systems: A Strong Fabric or the Emperor’s New Clothes?

This dissertation evaluates a model of factors that influence public trust in health information sharing in the context of a broadly defined health system. In the first of three analytical papers, I consider characteristics of the individuals in the U.S. population that predict system trust. These characteristics include demographic and psychosocial factors as well as knowledge, attitudes, and beliefs that are hypothesized to contribute to beliefs about the trustworthiness of the health system. The second paper examines the public’s trust in health information brokers – health care providers, public health departments and university researchers – and how this trust is associated with trust in the system generally. The third paper adds two contextual factors – policy environment and personal autonomy – to the investigation of system trust and its predictors. To evaluate each of these questions, I conducted a survey using a probability-based sample (n=1,011). Linear regression models predicting system trust explained more than 50% of the observed variability in system trust. Confidence in the policy environment, trust in healthcare providers, trust in researchers, and trustor characteristics such as having a favorable view of data sharing, having an expectation of benefit, identity theft, and altruism were positively associated with system trust. Knowledge negatively predicted system trust. Personal autonomy, privacy, belief in medical deception, experience, and demographic factors were not statistically significant after accounting for all other factors. As health information sharing becomes an increasingly ubiquitous practice resources would be well spent by communicating the personal and social benefits of data sharing and policy makers should not let issues such as privacy overshadow factors that are as much a concern for assuring trust. Public engagement may leverage trust in healthcare providers and researchers and should be authentic in efforts to build trust to avoid the danger of undermining trust by adding complexity to an already complicated system. Taken together, these efforts would more likely to strengthen public trust than efforts to fill knowledge gaps or shift responsibility for data sharing from the expert to the public.PhDHealth Services Organization and PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/110346/1/jeplatt_1.pd

Modelo de interoperabilidade semântica aplicado ao domínio da saúde : um estudo de caso na vigilância alimentar e nutricional

Dissertação (mestrado)—Universidade de Brasília, Instituto de Ciências Exatas, Departamento de Ciência da Computação, 2012.A histórica desarticulação dos Sistemas de Informação em Saúde (SIS) no Brasil, em especial dos sistemas do Sistema Único de Saúde (SUS), tem fragilizado a estrutura de gestão em saúde nas três esferas governamentais. A área de Informática em Saúde em conjunto com a área de Engenharia de Ontologias tem colaborado com técnicas e métodos de representação de conhecimento como instrumentos fundamentais para viabilizar a interoperabilidade semântica dos SIS. Nesta direção, este trabalho apresenta uma abordagem metodológica aplicada ao domínio da saúde de modelagem em dois níveis, o qual utiliza: (i) um modelo de referência, de mais alto nível ontológico, formado por conceitos amplamente consensuados, constituindo uma camada invariante de conceitos; (ii) modelos de conhecimento, chamado de arquétipos, consensuado em nível de aplicação, que busca através de múltiplas camadas de conceitos representar um nível mais flexível. Os arquétipos são utilizados como estruturas de representação de conhecimento que vem substituindo os níveis mais complexos de representação ontológica, os quais estruturam conhecimento em um nível mais próximo das aplicações. O tratamento de níveis variantes de conhecimento são viabilizados pelos arquétipos, possibilitando um mapeamento das ontologias de mais alto nível em ontologias de aplicação. Com a finalidade de avaliar a estrutura metodológica definida foi realizada uma prova de conceito utilizando o Sistema de Informação da Vigilância Alimentar e Nutricional brasileiro, no qual foram representados os conceitos e as informações do sistema. A partir destas estrutura de conceitos foram gerados extratos de dados semanticamente enriquecidos, mostrando um modelo de mapeamento ontológico de SIS. Os resultados alcançados pelos modelos definidos indicam que a modelagem de dois níveis apresenta uma solução viável para integrar SIS através de camadas ontológicas. O mapeamento por arquétipos entre níveis ontológicos reforçam o tratamento dos sistemas do SUS de forma consistente e interpretável. _______________________________________________________________________________________ ABSTRACTHealth Information Systems (HIS) in Brazil has been historically disarticulated, particulary the information systems of the brazilian Unified Health System (UHS). Three government spheres has been weakened in their management health structure because of this disarticulation. Studies in the area of Semantic Web has put the health ontologies as a fundamental part to enable the semantic interoperability of HIS and enable integrated access to information. In this sense we present the methodological approach applied in the health domain, two levels methodology: (i) reference model, the first level, is used a higher level ontological concepts made up of consensual concepts, constituting a invariant layer concepts, (ii ) knowledge models, called archetype, the application level, which searches through multiple layers of concepts represent a more flexible level of the same. The archetypes are used as frameworks for knowledge representation that is replacing the more complex levels of ontological representation. In practice, it is clear that the archetypes has been building a knowledge-level closer to the applications, i.e., variant levels of knowledge over the time, thus provides a mapping of ontologies to the highest level in the lower-level ontologies. A case study was conducted to assess the methodological framework defined. The Brazilian Information System for Food and Nutrition Surveillance was used in this work. Where archetypes are defined to represent the concepts and system information. Semantically enriched data extracts are generated from archetypes, showing a model of ontological mapping of HIS. In conclusion, the results achieved in applying the models in the study case, we present evidence that two-level modeling provides a viable solution to join HIS through ontological layers, which enables the mapping between ontological levels archetypes to enhance the treatment of systems of the UHS and consistently interpretable

Towards high performing hospital enterprise architectures : elevating hospitals to lean enterprise thinking

Thesis (Ph. D.)--Massachusetts Institute of Technology, Engineering Systems Division, 2011.Cataloged from PDF version of thesis.Includes bibliographical references (p. 608-630).This research is motivated by the National Academy of Engineering and the Institute of Medicine's joint call for research in healthcare, promoting the application of principles, tools, and research from engineering disciplines, and complex systems in particular. In 2005, the US healthcare expenditure represented 16% of its GDP, with hospitals representing the largest source of expenditure, as is the case in the United Kingdom. Consequently, the strategies and operations developed and implemented by hospitals have a significant impact on healthcare. Today, it would be hard to find a hospital that is not implementing a Lean initiative or who isn't familiar with its concepts. However, more often than not, their approach has narrowly focused at a process level and inside individual service units like an emergency department. This research seeks to elevate traditionally narrow hospital definitions of lean and explore the broader concepts of lean enterprise principles and Enterprise Architecture (EA) while enhancing our knowledge of hospitals' socio-technical complexity and enriching an emerging EA Framework (EAF) developed at the Massachusetts Institute of Technology (MIT). Following an extensive longitudinal multidisciplinary literature review, a number of expert interviews, and preliminary empirical findings, an exploratory inductive and deductive hybrid study was designed to collect and concurrently analyze both qualitative and quantitative empirical data from multiple hospital settings over two main phases: * The first phase consisted of recorded interviews with the Chief Executive Officers of seven leading Massachusetts hospitals, who also provided sensitive internal strategy and operations documents. We explored how hospitals currently measure their hospital performance and how their explicit and implicit practices may be improved using lean enterprise principles. e The second phase comprised two in-depth case studies of large leading multidisciplinary hospitals, one located in the US and other in the United Kingdom, and included a total of 13 embedded units of analysis. Multiple sources of evidence were collected including electronic medical records, 54 interviews, observation, and internal documents. Findings were categorized and sorted, as phenomena of interest consistently emerged from the data, and enriched both the EAF, and our understanding of hospitals' EA in particular. In both in-depth hospital cases we found that their EA consisted of multiple internal architectural configurations, and in particular, those with an enriched understanding of EA had made decisions which had improved not only their local performance, but also enhanced their interactions with other service units upstream and downstream. Conversely, worse performing configurations demonstrated a limited understanding of their hospital's EA. We conclude that hospital performance can be improved through an enriched understanding of hospital EA. Furthermore, whilst considering all hospitals included in this study, we propose general and specific recommendations, as well as diagnostic questions, performance dimensions, and metrics, to assist senior hospital leaders in architecting and managing their enterprise.by Jorge Miguel dos Santos Fradinho.Ph.D

Exploring complexity in community palliative care: a practitioner based approach to research and development

This thesis explores the complex discipline of community palliative care. Palliative patients suffer from a range of conditions, have complex, evolving clinical problems and receive care from a wide variety of health and social care professionals. Understanding these issues is central to effective service provision and maintaining continuity of care for patients and their carers. Current community palliative care provision in the UK is the result ofthe co-evolution of the emergent specialties of palliative and primary care over the past sixty years. A critical realist and practitioner based research approach is used in a multi-method study ofthe reasons for emergency admission ofpalliative patients into hospital and a qualitative study exploring the work and experiences of health care assistants prov~ding practical supportive care for palliative patients in their homes. Examining narratives of patients, carers and health professionals enables in depth exploration ofthe fundamental elements and contexts which define the inherent complexity ofthis area. Emergency admission ofpalliative patients represents a significant breach in continuity of care often resulting in disruption for both patient and health care services. The reasons for these admissions are many and complex. Relationships of power between different health professionals and between patients and health professionals exert a major influence on community palliative care provision and the process of admission. Health care assistants are relatively powerless and employed as basic carers, yet in community palliative care they undertake emotional labour, for which they draw on their personal resources. This aspect oftheir practice is crucial for patients and their carers; however it is largely unrecognised by formal health care services. Undertaking research in the context of a community palliative care team enables the development of a community of research practice. This provides an effective model for both developing an evidence base for community palliative care and the development of appropriate local services

Wellesley College Courses [2007-2008]

https://repository.wellesley.edu/catalogs/1105/thumbnail.jp