Academic Health Science Centers and Health Disparities: A Qualitative Review of the Intervening Role of the Electronic Health Record and Social Determinants of Health

Literature on the magnitude of negative health outcomes from health disparities is voluminous. Defined as the health effects of racism, environmental injustice, forms of discrimination, biases in science, and sociological or socioeconomic predictors across populations, health disparities are part of an ongoing and complicated national problem that health equity programs are specifically designed to address. Academic Health Science Centers (AHC) institutions are a complex and unique educational-healthcare ecosystem that often serves as a safety net for patients in vulnerable and lower-income communities. These institutions are often viewed as one of the most uniquely positioned entities in the U.S. with an abundance of resources and networks to advance health equity as a high-impact goal and strategic imperative. Relatively little progress, however, has been made to better understand the potentially transformative nature of how digital health technologies (DHT)—such as mobile health apps, electronic health record (EHR) and electronic medical record (EMR) systems, smart ‘wearable’ devices, artificial intelligence, and machine learning—may be optimized to better capture and analyze social determinants of health (SDH) data elements in order to inform strategies to address health disparities. Even less has been explored about the challenging implementation of electronic SDH screening and data capture processes within AHCs and how they are used to better inform decisions for patient and community care. This research examines how AHC institutions, as complex education-healthcare bureaucracies, have prioritized this specific challenge amongst many other competing incentives and agendas in order to ultimately develop better evidence-based strategies to advance health equity. While there are clear moral, ethical, and clinical motives for improving health outcomes for vulnerable populations, when an AHC demonstrates that electronically screening and capturing SDH can improve the ability to understand the “upstream” factors impacting their patients\u27 health outcomes, this can inform and influence policy-level choices in government legislation directed at community-level factors. A qualitative thematic analysis of interview data from AHC administrators and leadership illustrates how AHCs have mobilized their EHR as a featured component of their healthcare delivery system to address health disparities, exposing other related, multifactorial dimensions of the Institution and region. Key findings indicated that: electronic SDH screening and updating workflow processes within an AHC’s clinical enterprise is a significant venture with multiple risks and the potential of failure. Universal adoption and awareness of SDH screening is hampered by notions of hesitancy, skepticism, and doubt as to an AHC’s ability to meaningfully extract and use the data for decision-support systems. Additional investment in resources and incentive structures for capturing SDH are needed for continued monitoring of patient health inequalities and community social factors. Data from this and future replicated studies can be used to inform AHC and government decisions around health and social protection, planning, and policy

Electronic Health Record Optimization for Cardiac Care

Electronic health record (EHR) systems have been studied for over 30 years, and despite the benefits of information technology in other knowledge domains, progress has been slow in healthcare. A growing body of evidence suggests that dissatisfaction with EHR systems was not simply due to resistance to adoption of new technology but also due to real concerns about the adverse impact of EHRs on the delivery of patient care. Solutions for EHR improvement require an approach that combines an understanding of technology adoption with the complexity of the social and technical elements of the US healthcare system. Several studies are presented to clarify and propose a new framework to study EHR-provider interaction. Four focus areas were defined - workflow, communication, medical decision-making and patient care. Using Human Computer Interaction best practices, an EHR usability framework was designed to include a realistic clinical scenario, a cognitive walkthrough, a standardized simulated patient actor, and a portable usability lab. Cardiologists, fellows and nurse practitioners were invited to participate in a simulation to use their institution’s EHR system for a routine cardiac visit. Using a mixed methods approach, differences in satisfaction and effectiveness were identified. Cardiologists were dissatisfied with EHR functionality, and were critical of the potential impact of the communication of incorrect information, while displaying the highest level of success in completing the tasks. Fellows were slightly less dissatisfied with their EHR interaction, and demonstrated a preference for tools to improve workflow and support decision-making, and showed less success in completing the tasks in the scenario. Nurse practitioners were also dissatisfied with their EHR interaction, and cited poor organization of data, yet demonstrated more success than fellows in successful completion of tasks. Study results indicate that requirements for EHR functionality differ by type of provider. Cardiologists, cardiology fellows, and nurse practitioners required different levels of granularity of patient data for use in medical decision-making, defined different targets for communication, sought different solutions to workflow which included distribution of data input, and requested technical solutions to ensure valid and relevant patient data. These findings provide a foundation for future work to optimize EHR functionality

USD Magazine Summer 2020

Dear Toreros; Torero News; Torero Athletics; #Toreros Together; Nurses do Wonderful Things; In a Word: Resilience; Class Notes; Dear Toreroshttps://digital.sandiego.edu/usdmagazine/1098/thumbnail.jp

A Study Identifying Information Technology Development Strategies for Nursing Professional Development Specialists Practicing in Healthcare Settings

The increased use of information systems (IS) in healthcare institutions, federal health information technology (IT) policy mandating the use of information systems in patient care, and the nursing informatics agenda force healthcare organizations to address the informatics competency of its workforce (Murphy, 2010). This study validates IT competencies for Nursing Professional Development (NPD) Specialists and determines self-directed, informal learning strategies for developing information technology competency. The NPD Specialist is responsible for the professional development of nursing caregivers in healthcare settings. This study validated 53 IT competencies for the NPD Specialist role in healthcare settings. The validated competencies include current healthcare technology, federal health IT policy, evidence-based practice, and other necessary topics within healthcare. This study regarded 41 competencies (of the 53 validated IT competencies) as high importance, or essential, to the NPD Specialists role in healthcare settings today. Strategies were also identified for developing the essential IT competencies. The NPD Specialists and leaders within healthcare organizations can use the validated essential IT competencies and development strategies from this study to build IT competency amongst its workforce (ANA, 2010)

Exploring Strategies for Implementing Data Governance Practices

Data governance reaches across the field of information technology and is increasingly important for big data efforts, regulatory compliance, and ensuring data integrity. The purpose of this qualitative case study was to explore strategies for implementing data governance practices. This study was guided by institutional theory as the conceptual framework. The study\u27s population consisted of informatics specialists from a small hospital, which is also a research institution in the Washington, DC, metropolitan area. This study\u27s data collection included semi structured, in-depth individual interviews (n = 10), focus groups (n = 3), and the analysis of organizational documents (n = 19). By using methodological triangulation and by member checking with interviewees and focus group members, efforts were taken to increase the validity of this study\u27s findings. Through thematic analysis, 5 major themes emerged from the study: structured oversight with committees and boards, effective and strategic communications, compliance with regulations, obtaining stakeholder buy-in, and benchmarking and standardization. The results of this study may benefit informatics specialists to better strategize future implementations of data governance and information management practices. By implementing effective data governance practices, organizations will be able to successfully manage and govern their data. These findings may contribute to social change by ensuring better protection of protected health information and personally identifiable information

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Self-employed registered nurses : the impact of liminality and gender on professional identities and spaces : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Manawatū, Aotearoa New Zealand

Copyrighted material has been re-used with permission or is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) license.This thesis explores the experiences of self-employed registered nurses in Aotearoa New Zealand working in the practice area of professional advice and policy. Liminality theory and gender theory, with a feminist post-structuralist lens, were used as theoretical approaches. The participants spanned the masculinist areas of business, self-employment and policy, while connected by a strong bond to the normatively feminine nursing profession. Considering these views using a gendered lens and the participants’ position as outsiders to both business and nursing proved a powerful way to interpret the data. The research was conducted using focused ethnography, enabling interviews and observation of the 13 participants’ home-based workspaces. Data chapters incorporate the phases of liminality, separation, transition and re-aggregation, all of which provided a strong foundation underpinning the participant journey. The participant group of mid- to late-career registered nurses had high levels of education, practice experience and skillsets, which could be used across nursing and the whole of health, yet due to their liminal and individualistic positioning the nurses remained invisible, both physically and professionally. Outcomes included insight into why the participants chose self-employment, the gendered assumptions they faced, the difficulties of learning new skills when separated from familiar resources and support systems and the tensions of working from home. The participants, while each at different stages, followed the phases of liminality in acculturating to self-employment, but remained in a permanent limonoid state for other aspects of their work life. My findings indicate that, anchored by historical discourses, nursing remains a devalued feminised occupation. Captured in gendered subjective positioning, the participants navigate complex and competing discourses in relation to work, home, profession and belonging

Strategies That Improve UX (User Experience) Design Through Product Innovation

User Experience (UX) design improvement can alter business results. Information technology (IT) company leaders are concerned with UX design improvement, as it is the number one indication of product innovation success and user satisfaction. Grounded in Christensen’s disruptive innovation theory, the purpose of the qualitative single case study was to explore strategies IT company leaders and UX designers used to identify critical UX design elements that lead to improved product innovations. The participants were five IT company leaders and a focus group of four UX designers employed by a sizeable telecom organization in Beijing, China. The data were collected from five semistructured interviews and the focus group discussion. Through thematic analysis, five themes emerged: cultivate a user-centered company culture, improve UX design basic factors, focus on the users, measure UX design key performance indicators, and optimize the UX design process. The primary recommendation is for business leaders to cultivate a user-centered culture through building a user-centered belief across the organization and reaching support from the senior management. The implications for positive social change include the potential to develop useful products that may help users solve real-life problems and enhance their quality of life