Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings

Modeling the Adoption of Identification Standards Within the Healthcare Supply Chain

The adoption of identification standards and its associated technology in the healthcare supply chain has been slow over the past twenty five years, despite the evidence of the benefits that can be achieved. The widespread use of identification standards in the form of barcode labeled medical products can contribute to the reduction of point of care errors and can increase the efficiency of healthcare supply chain related processes. This research is focused on the analysis of the adoption of identification standards in the healthcare supply chain with a particular focus on the healthcare provider adoption challenges. The research is divided into two phases. The first phase develops an extensive literature review on technology adoption with a particular focus on data standards. This adoption process is compared with the adoption of Electronic Health Records (EHR) and Electronic Data Interchange (EDI); main conclusions from the identification standards literature are presented, and a conceptual model to explain the identification-standards adoption process is proposed. The second phase proposes a model for identification standards adoption using a system dynamics modeling approach. The model builds on previous findings associated to the factors affecting identification standards adoption and relates the specific elements to the adoption rate via a causal loop diagram (CLD). The model is formulated in two stages. In the first stage, the Bass Diffusion Model (BDM) of technology adoption is adapted to simulate the adoption of identification standards supporting technologies. The second stage uses most of the factors defined in the CLD to develop a simulation model. A sensitivity analysis identifies relevant model parameters that facilitated the design of interventions to move the adoption process forward. Finally, the effects of some possible interventions are simulated using the validated model. The model provides an illustration of the use of system dynamics models and diffusion theory to understand an important policy problem reported in the literature and not yet solved. Also this research informs real world practitioners and the academic community on issues like the lack of data and other challenging aspects of empirical research that can be addressed with the proposed model and methodology

Electronic Health Record Systems Investment Valuation: A System Dynamics Approach

Implementing Electronic Health Record (EHR) systems is on the agenda for most of the healthcare organizations in the next few years. Decision makers need to do a cost-benefit analysis to value EHR investments. The major question for decision makers is what the benefits of such systems are. We propose the use of System Dynamics (SD) to measure the benefits of EHR systems. A System dynamics approach as a predictive tool maps complex relationships among the healthcare processes into a model by which one can dynamically measure the effect of any changes in the parameters over time. The System dynamics model’s objective is to analyze the impact of EHRs in a healthcare setting during and after its implementation. Simulation of EHR implementations using system dynamics model produces useful data on the benefits of EHRs that are hard to obtain through empirical data collection methods. The results of an SD model then can be transformed into economic values to estimate financial indices

Proposing a roadmap for HealthGrids

Présentation commune des éditeur

Adoption of Electronic and Personal Health Records: An Ecconomic Analysis

We investigate strategic issues surrounding the adoption of electronic health records (EHR) and personal health records (PHR) using an economic framework. Through our analysis, we find evidence that health care providers do not have an incentive to implement interoperable EHR systems even though the implementation of EHR systems (interoperable or otherwise) will increase consumer surplus. In this context, we conjecture that PHR platforms can fundamentally alter the incentives of health care providers, potentially leading to increased EHR adoption under some conditions. In a pluralistic health care system like that which exists in the United States, where health care providers have varying incentives to implement interoperable electronic health records, an online PHR platform can provide an alternative means for consumers to freely exchange their health records among different providers

Harnessing Openness to Transform American Health Care

The Digital Connections Council (DCC) of the Committee for Economic Development (CED) has been developing the concept of openness in a series of reports. It has analyzed information and processes to determine their openness based on qualities of "accessibility" and "responsiveness." If information is not available or available only under restrictive conditions it is less accessible and therefore less "open." If information can be modified, repurposed, and redistributed freely it is more responsive, and therefore more "open." This report looks at how "openness" is being or might usefully be employed in the healthcare arena. This area, which now constitutes approximately 16-17 percent of GDP, has long frustrated policymakers, practitioners, and patients. Bringing greater openness to different parts of the healthcare production chain can lead to substantial benefits by stimulating innovation, lowering costs, reducing errors, and closing the gap between discovery and treatment delivery. The report is not exhaustive; it focuses on biomedical research and the disclosure of research findings, processes of evaluating drugs and devices, the emergence of electronic health records, the development and implementation of treatment regimes by caregivers and patients, and the interdependence of the global public health system and data sharing and worldwide collaboration

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

Progress along developmental tracks for electronic health records implementation in the United States

The development and implementation of electronic health records (EHR) have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a) Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP), (b) Regional Health Information Organization (RHIO) demonstration projects to link together patient medical records, (c) Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d) Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States

The Second International Conference on Health Information Technology Advancement

TABLE OF CONTENTS I. Message from the Conference Co-Chairs B. Han and S. Falan …………………………....….……………. 5 II. Message from the Transactions Editor H. Lee …...………..………….......………….……….………….... 7 III. Referred Papers A. Emerging Health Information Technology and Applications The Role of Mobile Technology in Enhancing the Use of Personal Health Records Mohamed Abouzahra and Joseph Tan………………….……………. 9 Mobile Health Information Technology and Patient Care: Methods, Themes, and Research Gaps Bahae Samhan, Majid Dadgar, and K. D. Joshi…………..…. 18 A Balanced Perspective to Perioperative Process Management Jim Ryan, Barbara Doster, Sandra Daily, and Carmen Lewis…..….…………… 30 The Impact of Big Data on the Healthcare Information Systems Kuo Lane Chen and Huei Lee………….…………… 43 B. Health Care Communication, Literacy, and Patient Care Quality Digital Illness Narratives: A New Form of Health Communication Jofen Han and Jo Wiley…..….……..…. 47 Relationships, Caring, and Near Misses: Michael’s Story Sharie Falan and Bernard Han……………….…..…. 53 What is Your Informatics Skills Level? -- The Reliability of an Informatics Competency Measurement Tool Xiaomeng Sun and Sharie Falan.….….….….….….…. 61 C. Health Information Standardization and Interoperability Standardization Needs for Effective Interoperability Marilyn Skrocki…………………….…….………….… 76 Data Interoperability and Information Security in Healthcare Reid Berryman, Nathan Yost, Nicholas Dunn, and Christopher Edwards.…. 84 Michigan Health Information Network (MiHIN) Shared Services vs. the HIE Shared Services in Other States Devon O’Toole, Sean O’Toole, and Logan Steely…..……….…… 94 D. Health information Security and Regulation A Threat Table Based Approach to Telemedicine Security John C. Pendergrass, Karen Heart, C. Ranganathan, and V.N. Venkatakrishnan …. 104 Managing Government Regulatory Requirements for Security and Privacy Using Existing Standard Models Gregory Schymik and Dan Shoemaker…….…….….….… 112 Challenges of Mobile Healthcare Application Security Alan Rea………………………….……………. 118 E. Healthcare Management and Administration Analytical Methods for Planning and Scheduling Daily Work in Inpatient Care Settings: Opportunities for Research and Practice Laila Cure….….……………..….….….….… 121 Predictive Modeling in Post-reform Marketplace Wu-Chyuan Gau, Andrew France, Maria E. Moutinho, Carl D. Smith, and Morgan C. Wang…………...…. 131 A Study on Generic Prescription Substitution Policy as a Cost Containment Approach for Michigan’s Medicaid System Khandaker Nayeemul Islam…….…...……...………………….… 140 F. Health Information Technology Quality Assessment and Medical Service Delivery Theoretical, Methodological and Practical Challenges in Designing Formative Evaluations of Personal eHealth Tools Michael S. Dohan and Joseph Tan……………….……. 150 The Principles of Good Health Care in the U.S. in the 2010s Andrew Targowski…………………….……. 161 Health Information Technology in American Medicine: A Historical Perspective Kenneth A. Fisher………………….……. 171 G. Health Information Technology and Medical Practice Monitoring and Assisting Maternity-Infant Care in Rural Areas (MAMICare) Juan C. Lavariega, Gustavo Córdova, Lorena G Gómez, Alfonso Avila….… 175 An Empirical Study of Home Healthcare Robots Adoption Using the UTUAT Model Ahmad Alaiad, Lina Zhou, and Gunes Koru.…………………….….………. 185 HDQM2: Healthcare Data Quality Maturity Model Javier Mauricio Pinto-Valverde, Miguel Ángel Pérez-Guardado, Lorena Gomez-Martinez, Martha Corrales-Estrada, and Juan Carlos Lavariega-Jarquín.… 199 IV. A List of Reviewers …………………………..…….………………………208 V. WMU – IT Forum 2014 Call for Papers …..…….…………………20

Addendum to Informatics for Health 2017: Advancing both science and practice

This article presents presentation and poster abstracts that were mistakenly omitted from the original publication