Understanding Challenges and Solutions with Systemigrams: Application to Electronic Medical Record Systems

The medical field is becoming bigger and more complex in the 21st century, diseases both emergent and re-emergent are on the rise and are costing lives around the world. Evolution of many diseases has made people find a reason to seek medical care in healthcare centers. This has led to increased development of health care facilities as peoples’ urge to get quality diagnosis and treatment rises. However, in the past patients ended up waiting a long time in their efforts to obtain these services. These wait times were due to the lack of proper documentation and recording of the personal information. Hospitals and health centers had to hire an increased numbers of health practitioners to handle the paper work as patient populations increased. Due to the massive amount of issues experienced and the patient agony, healthcare professionals were prompted to develop fast, reliable and efficient methods of handling large amounts of data within a short time. The rise of digital technologies enables the Electronic Medical Records (EMR) system to be utilized in the healthcare setting. This tool has revolutionized the whole spectrum of capturing and recording medical health data. Today, health care agencies and organizations can retrieve and store a patient’s personal health information where physicians can readily access this information from their offices. Therefore, EMR is the real time solution to the health information management problem and through it there will be an improved patient experience in terms of wait time, diagnosis, and treatment. However, there are some challenges that come with the system that should be addressed to ensure efficiency. After a systemic review of the literature, we have used a systemigram approach and modeled the current challenges of EMR implementation and the related solutions to EMR system adoption. The objective of this study is to provide a systems-thinking approach to better contextualize the role of EMR in the complex system of healthcare from a multi-stakeholder perspective

Information needs in the day-to-day operations management of hospital units

Day-to-day operations management of hospital units is complex due to several actors, changing situations and various information systems in use. Responsible professionals face challenges to obtain important information for managerial decision-making. The aim of this study was to model important information needed in the day-to-day operations management of hospital units. The study had an observational design. The professionals responsible are here referred to as ‘shift leaders’ and they included nurses and physicians in charge. Data were collected in 2012–2016. First, a literature review was done to describe information systems developed for the day-to-day operations management of hospital units. Second, an instrument for exploring information needed in the day-to-day operations management of hospital units was developed and tested. Third, a national survey was done to model important information needed in the day-to-day operations management of hospital units. Thereafter, one information model was clinically tested. The findings showed that numerous information systems have been developed for professionals responsible for the day-to-day operations management of hospital units, but these do not adequately support managerial decision-making. The instrument for exploring information needed in the day-to-day operations management of hospital units was valid and reliable, and data collected with it showed that the needs differed between professionals, time of day and types of units. The largest difference was between professionals. Nurses’ important information needs covered patients, personnel and materials, while physicians’ needs focused on patient care. Categories of important information for the model were determined by factor analysis for these different user groups. The final model of important information had ten information categories, all of which were needed by different user groups that had a different set of individual items. This model may be used to develop and improve information processing in the day-to-day operations management of hospital units to support the safe, efficient and cost-effective provision of care.Tiedon tarpeet sairaalayksikön päivittäisen toiminnan johtamisessa Sairaalayksikön päivittäisen toiminnan johtamien on haastavaa usean toimijan, muuttuvien tilanteiden ja lukuisten käytössä olevien tietojärjestelmien vuoksi. Toiminnasta vastaavilla ammattilaisilla on vaikeuksia saada tärkeää tietoa päätöksenteon tueksi. Tutkimuksen tarkoitus oli mallintaa sairaalayksikön päivittäisen toiminnan johtamisessa tarvittavia tärkeitä tietoja. Tutkimusasetelma oli havainnoiva. Toiminnasta vastaavat ammattilaiset olivat sairaanhoitajia ja lääkäreitä. Aineistot kerättiin vuosina 2012–2016. Aluksi kuvattiin sairaalayksikön päivittäisen toiminnan johtamiseen kehitettyjä tietojärjestelmiä kirjallisuuskatsauksella. Toiseksi, kehitettiin ja testattiin mittari, jolla voitiin tarkastella tiedon tarpeita sairaalayksikön päivittäisen toiminnan johtamisessa. Kolmanneksi, tehtiin kansallinen kysely, jonka perusteella sairaalayksiköiden päivittäisen toiminnan johtamisessa tarvittavia tärkeitä tietoja voitiin mallintaa. Lopuksi, yksi malli testattiin kliinisessä ympäristössä. Päivittäisen toiminnan johtamiseen on tulosten perusteella kehitetty lukuisia tietojärjestelmiä, mutta ne tukevat johtamisen päätöksentekoa vain osin. Sairaalayksikön päivittäisen toiminnan johtamisen tiedontarpeiden selvittämiseen kehitetty mittari osoittautui validiksi ja reliaabeliksi. Mittarilla kerätty tieto osoitti, että tiedontarpeet eroavat ammattiryhmän, ajankohdan ja sairaalayksikön mukaan. Suurin ero oli ammattiryhmien välillä. Sairaanhoitajat tarvitsivat tietoa potilaista, henkilöstöstä ja materiaaleista kun taas lääkäreiden tarpeet keskittyivät potilashoitoon. Käyttäjäryhmien tärkeitä tietosisältöjä jäsenneltiin faktorianalyysin avulla. Tärkeiden tietojen malli koostui yhteensä kymmenestä tietokategoriasta, jotka vaihtelivat käyttäjäryhmittäin. Myös kategorioiden sisällä olevat yksittäiset tiedon tarpeet vaihtelivat käyttäjäryhmillä. Tämä korostaa joustavien ja käyttäjälähtöisesti räätälöityjen tietojärjestelmien tarvetta. Mallia voidaan käyttää tietojen käsittelyn kehittämiseen sairaalayksiköiden päivittäisen toiminnan johtamisessa, jotta paremmin tuetaan turvallisia, vaikuttavia ja kustannustehokkaita palveluita

Integrated welfare systems and disclosure. Approaching emerging issues

The aim of this paper is to investigate the integrated welfare and disclosure by proposing emerging issues in the contemporary scenario. Thus, company welfare is represented as internal sociability; environmental protection or innovation can be interpreted as external sociability, representing the uses of resources that a company does not incur costs, but demonstrates its health and social responsibility. Following a theoretical approach, the paper proposes as result a conceptual study introducing an updated literature analysis on the topic proposed of the integrated welfare systems and disclosure trying to point out emerging issues through a case study. Moreover, the research methodology is based on a qualitative approach and secondary sources in order to propose not only to scientific community a literature analysis. In this way, the implications of the research can be directed to academic communities and policy makers. The research question is the following: Which are emerging issues on the integrated welfare and its disclosure

The Impact of Individual Learning on Electronic Health Record Routinization: An Empirical Study

Since the passage of the HITECH Act, adoption of electronic health records (EHR) has increased significantly EHR refers to an electronic version of a patient’s medical history. The adoption of EHR has potential to reduce medical errors, duplication of testing, and delays in treatment. However, current literature indicates that implementation of EHR is not resulting in the automatic routinization of EHR. Routinization refers to the notion that truly successful technological innovations are no longer perceived as being new or out-of-the-ordinary. The complexity of EHRs allow individual users to use these systems at different levels of sophistication. Research shows that healthcare professionals are using non-standard ways to use or circumvent the EHR to complete their work and are limited in EHR systems use. Further, although workarounds may seem necessary to physicians and are not perceived to be problematic, they can pose a threat to patient safety and hinder the potential benefits. Hence, we argue the EHR implementations are limited in their potential due to the lack of routinization. Any new technological innovation requires the physician support and willingness to learn about the system to move to the routinization phase of implementation. Hence, we draw from the literature on organization learning, individual learning, and routines to understand factors that influence EHR routinization

“Doing What Needs To Be Done”: An Ethnographic Study Of The Roles And Work Of Mongolian Medical-Surgical Ward Nurses

Purpose: The purpose of this research is to identify the roles and work activities of nurses working in Mongolian public hospitals and to compare it to what is known about nurses’ work in other countries in order to inform policy and service development within the Mongolian health system. Design: An ethnographic methodology, viewed through the lens of critical realism, was used to develop a description of medical and surgical ward nursing in public hospitals in Mongolia. Procedure: 208 hours of participant observation and 9 semi-structured interviews were used to generate data from one medical ward in a secondary level care hospital and a medical and a surgical ward at a tertiary level care hospital in Ulaanbaatar. Constant comparison was used to identify activities nurses do and the roles they fulfill. To facilitate comparison with findings from other countries, an integrative literature review was undertaken to identify nursing work activities from an international perspective. Findings: A model of Acute Care Nursing Work was developed that describes the work of medical and surgical ward nurses according to three core nursing functions: patient care, ward functioning, and professionalism. While these core functions are present both internationally and in Mongolia, Mongolian nursing was assessed as having more ward functioning activities than in many other countries. Conclusions: Medical-surgical nurses on Mongolian public hospital wards are responsible not only for patient care, but for ensuring the ward functions in a way that meets patient needs. While some of these expectations have their roots in the Soviet model of nursing on which Mongolian nursing was founded, many work activities are the pragmatic result of nurses doing what needs to be done to facilitate the carrying out of doctors’ orders. As many of nursing’s roles and work activities are shaped not only by nursing policies and practices, but by medical practices, hospital funding, staff-mix, and government leadership, proposed changes to nurses’ work should done in concert with government, education, and health sectors. The Model of Acute Care Nursing Work can help with assessment and understanding of the roles and work activities of nurses and the factors that influence it

The Impact of Individual Learning on Electronic Health Record Routinization: An Empirical Study

Since the passage of the HITECH Act, adoption of electronic health records (EHR) has increased significantly EHR refers to an electronic version of a patient’s medical history. The adoption of EHR has potential to reduce medical errors, duplication of testing, and delays in treatment. However, current literature indicates that implementation of EHR is not resulting in the automatic routinization of EHR. Routinization refers to the notion that truly successful technological innovations are no longer perceived as being new or out-of-the-ordinary. The complexity of EHRs allow individual users to use these systems at different levels of sophistication. Research shows that healthcare professionals are using non-standard ways to use or circumvent the EHR to complete their work and are limited in EHR systems use. Further, although workarounds may seem necessary to physicians and are not perceived to be problematic, they can pose a threat to patient safety and hinder the potential benefits. Hence, we argue the EHR implementations are limited in their potential due to the lack of routinization. Any new technological innovation requires the physician support and willingness to learn about the system to move to the routinization phase of implementation. Hence, we draw from the literature on organization learning, individual learning, and routines to understand factors that influence EHR routinization

The impact of information quality awareness on users\u27 behaviors toward information quality practices

Healthcare organization rely more on electronic information to optimize most of their processes. Additional information sources and more diverse information increase the relevance and importance of information quality (IQ). The quality of information needs to be improved to support a more efficient and reliable utilization of information systems (IS). This improvement can only be achieved through the implementation of initiatives followed by most users across the organization. The purpose of this study is to develop a model related to how awareness of IS users about IQ issues would affect their actual practices toward IQ initiatives. It is posited that users’ motivation is influenced by their awareness on beneficial and problematic situations generated by IQ. The motivation that users may have regarding IQ impact, will influence their behavior regarding IQ practices. Social influences and facilitating conditions are considered as moderators of the interaction between intention and actual users’ behavior

Change is inevitable but compliance is optional : coworker social influence and behavioral work-arounds in the EHR implementation of healthcare organizations

textThe implementation of planned organizational change is ultimately a communication-related phenomenon, and as such, it is imperative that organizational communication scholars examine the interactions surrounding EHR implementation and understand how users (e.g. healthcare practitioners) utilize, evaluate, and deliberate this new technological innovation. Previous research on planned organizational change has called for researchers to adopt a more dynamic perspective that emphasizes the active agency of organizational members throughout implementation processes and focuses on informal implementers and change reinvention (work-arounds) as individuals actively reinterpret and personalize their work roles during implementation socialization. This dissertation seeks to fill this gap in research by demonstrating how communication between doctors, nurses, and other health professionals affects the adoption, maintenance, alternation, modification, or rejection of EHR systems within health care organizations. To delve into these inquiries and examine the intersecting domains of medical informatics and organizational communication research, this dissertation proceeds in the following manner: First, a literature review, capitalizing on Laurie Lewis’s work in planned organizational change and social constructionist views of technology use in organizations, outlines the assumptions that undergird this research. Next, this dissertation builds a model that predicts the communicative and structural antecedents of the study outcome variables, which include 1) organizational resistance to EHR implementation, 2) employees’ perception of EHR implementation success, 3) levels of change reinvention—or work-arounds—due to change initiatives and activities, and 4) employees’ perceptions of the quality of the organizational communication surrounding the change. Hypotheses guiding the model specification are provided and are followed by a description of the empirical methods and procedures that were utilized to explore the variable relationships. Results of the SEM model suggest that work-arounds could play a mediating role governing the relationship between informal social influence and the outcome variables in the study. In addition, one-way ANOVAs and multiple regression analyses reveal that physicians are the most resistant to EHR implementation and perceived change communication quality positively predicts perceived EHR implementation success and perceived relative advantage of EHR and negatively predicts employee resistance. A discussion of the expected and unexpected results is offered in addition to study limitation and future directions.Communication Studie

Decision Support Systems

Decision support systems (DSS) have evolved over the past four decades from theoretical concepts into real world computerized applications. DSS architecture contains three key components: knowledge base, computerized model, and user interface. DSS simulate cognitive decision-making functions of humans based on artificial intelligence methodologies (including expert systems, data mining, machine learning, connectionism, logistical reasoning, etc.) in order to perform decision support functions. The applications of DSS cover many domains, ranging from aviation monitoring, transportation safety, clinical diagnosis, weather forecast, business management to internet search strategy. By combining knowledge bases with inference rules, DSS are able to provide suggestions to end users to improve decisions and outcomes. This book is written as a textbook so that it can be used in formal courses examining decision support systems. It may be used by both undergraduate and graduate students from diverse computer-related fields. It will also be of value to established professionals as a text for self-study or for reference