Factors affecting the adoption and use of Electronic Patient Record (EPR) systems in cancer treatment services

Background: Healthcare services around the world have developed computerised information systems to gradually replace traditional paper-based medical records. In oncology services, a diverse range of multi-organisational patient record systems are currently undergoing continuous development and improvement. Achieving technology acceptance in clinical environments is a complex aspect of the development and implementation of socio-technical systems. Whilst there has been previous research conducted about technology acceptance in oncology, gaps and limitations remain unexplored, particularly in relation to the full range of EPR system functionality. From a clinical end users’ perspective, this research aimed to discover the factors that influence clinicians’ attitudes towards and their use of oncology EPR systems. Methodology: This mixed methods research comprised two studies. In the first exploratory study, a patient records survey questionnaire was conducted to gather information about participants’ use of patient records and clinical information systems at a large regional cancer hospital. The findings and themes that emerged from the first study were used in conjunction with a social-technical systems theoretical framework to design and structure the second study. In the second study, in-depth qualitative interviews were conducted with oncologists to further investigate their views and identify key factors that affect their adoption and use of EPR systems. Phenomenography was used as the main qualitative approach for analysing the interview transcripts, and the researcher identified categories of description and the “outcome space” that explains the different ways that oncologists think about EPR systems. Following triangulation of the results, the findings were developed into recommendations for further research and practical guidance for health informatics practitioners in the form of a conceptual reference model, CICERO (Comprehensive, Integrated, Customised Electronic Records for Oncology). Findings: The exploratory study found that while the majority of respondents found the existing EPR systems easy to use, a range of factors affected the full adoption and use of these systems. Medical staff, in particular, reported problems with accessibility, integration, and usability. The qualitative study found that the alignment of technology, tasks, and individuals could be improved with increased emphasis on understanding the fit between oncologists and the clinical tasks they perform. Phenomenographical analyses produced an outcome space that included three categories of description related to the qualitatively different ways in which oncologists think about EPR systems. In the first category, oncologists thought of EPR systems as a simple legal record of a patient’s care and treatment; in the second category, where most oncologists were positioned, they viewed EPR systems as a means of providing information to aid memory and communication; and in the third category, oncologists thought of EPR systems as advanced tools for clinical workflow, decision support, and interoperability. Conclusion: Various socio-technical factors should be considered when designing, developing, and implementing EPR systems in oncology, with a view to maximising technology acceptance by clinical end users. In line with prior studies, the key factors identified were accessibility, integration, and usability. Additional factors included clinical staff participation in system design and development activities. In summary, oncologists are more likely to perceive EPR systems in the third category of description and adopt them if they can see specific benefits being gained from their use. Keywords: Oncology, information systems, electronic patient records, technology acceptance, cancer services, socio-technical systems

Impact of the Increased Use of Telehealth on Health Care Management and Administration: The Case of New Care Management Practices

The COVID-19 pandemic has brought unprecedented challenges to healthcare systems worldwide, forcing them to adapt and implement alternative modes of healthcare delivery quickly. Telehealth, the delivery of healthcare services through telecommunication technologies, has become crucial in providing continuous care while reducing the risk of virus transmission. This qualitative study aimed to explore healthcare managers\u27 perceptions of the use of telehealth and its impact on healthcare practices during the pandemic, particularly in terms of provision and quality control. A purposive sample of 10 healthcare managers from different healthcare settings in the United States participated in semi-structured interviews conducted via video conferencing. The interviews were transcribed and analyzed using thematic analysis. The findings revealed six overarching themes: (1) perceived benefits of telehealth, including increased accessibility, convenience, and efficiency; (2) challenges and limitations of telehealth; (3) role of telehealth in shaping healthcare practices; (4) implications for quality control, including the need for standardization, training, and evaluation measures; (5) leadership and innovation in telehealth; and (6) future of telehealth in healthcare management. This study provides insights into how healthcare managers perceive the use of telehealth and how it shapes healthcare practices during the COVID-19 pandemic. The findings suggest that telehealth can potentially improve healthcare provision and quality control, but its implementation requires addressing challenges and limitations and adapting to evolving healthcare needs. Future research can build on these findings by exploring the perspectives of other stakeholders, such as healthcare providers and patients, and examining the long-term effects of telehealth on healthcare practices

Examining the Design and Usability of Telemedicine Communications: A Mixed-methods Study

This dissertation describes a mixed-methods study that examines the usability of telemedicine provider interfaces. This study consisted of content analysis, survey, and think aloud methodologies, which afford a multifaceted corpus of data for which to draw inferences and identify design features and functions that negatively impact usability. Usability is a critical component of the user experience with a telemedicine provider interface and can suede or impede the acceptance and adoption of telemedicine. Telemedicine has the potential to increase quality healthcare access and positive health outcomes for individuals who use it, and usability is a key component of technology acceptance and effective use. Empirical testing of health information technology (HIT) and telemedicine is advocated for as it is the most valuable method of research to understand humans\u27 cognitive processing of information as they interact with technology. In addition, using activity theory and mobile interface theory as a lens in which to understand human activities and interaction with telemedicine provider interfaces, including the telemedicine provider websites and their mobile-responsive websites in this study, is an effective tool for drawing reasonable inferences regarding the usability of telemedicine communications. Considering the rate at which an unprecedented amount of health information becomes available online and HIT facilitates the delivery of healthcare, usability testing and user-centered, iterative design practices become increasingly essential in order to design effective—and safe—health information and technology that enhance the patient-experience, the affordability and accessibility of healthcare, health literacy and patient empowerment, and positive health outcomes. Usability testing plays an increasingly important role in characterizing obstacles to achieving these initiatives of the modern patient-centered health paradigm and telemedicine. The mixed-methods usability testing performed in this study offers a principled approach to usability testing and is ecologically valid because it involves real human subjects. This study fulfills a void in research on the usability of telemedicine communications and reveals usability problems that may not be anticipated by designers of HIT and health information providers. Drawing from the insight gained from this mixed-method study, design features and functions that enhance the usability of health communications are offered. This study draws insight from the human factors, technical communication, and health and medical fields to develop systematic, practical usability testing methods that can be replicated and applied in many fields. The design recommendations resulting from this study will be valuable to programmers; systems analysts; clinicians and nurses; technical communicators; information architects; visual designers; and others in similar roles

Semantic discovery and reuse of business process patterns

Patterns currently play an important role in modern information systems (IS) development and their use has mainly been restricted to the design and implementation phases of the development lifecycle. Given the increasing significance of business modelling in IS development, patterns have the potential of providing a viable solution for promoting reusability of recurrent generalized models in the very early stages of development. As a statement of research-in-progress this paper focuses on business process patterns and proposes an initial methodological framework for the discovery and reuse of business process patterns within the IS development lifecycle. The framework borrows ideas from the domain engineering literature and proposes the use of semantics to drive both the discovery of patterns as well as their reuse

Design and evaluation of business process oriented assessment techniques to determine the quality of information exchanges -demonstrated in public organizations-

This thesis investigates information quality (IQ) of information exchange in public organizations. A clear relation between the quality of information and success of organizations has been acknowledged, but approaches for analyzing information quality on the basis of higher abstraction level have been lacking. When examining organizations, limited understanding of information processes relating to information exchanges are often observed. As the example of emergency medical service demonstrates, this is particularly true within public service organizations. In this thesis, a set of techniques for IQ analysis are developed and evaluated, namely quality assessment for information exchange (QA.IE) techniques. This extends previously developed methods and provides a novel way to assess IQ, complementing data oriented approaches that have been often proposed in research in the last years. Design of the QA.IE techniques is undertaken in the public service within the emergency medical service, where information exchange utilize various forms of media and are known to be of critical importance. The research follows a design science (DS) approach. The analysis is based on data from interviews, in depth field investigations, and surveys. Evaluation of the QA.IE techniques are carried out in the operating room within a large hospital in Ireland and Counter of Lost Wallet (BPC) for e-Citizen service in Portugal. Within the work, an evaluation framework was developed which formed the basis for evaluating the techniques and is comprised of demonstration, design principles, interviews, and Moody and Shanks factors. The resulting QA.IE techniques provide models to evaluate the state of IQ in information exchange with consideration of enterprise contexts. The results can be utilized as guidelines when planning and assessing information and information exchange related matters, and facilitate digitalization for improvement. Suggestions concerning further development for future use of the techniques are formulated, and consolidated into principle for IQ assessment. This thesis thus contributes theoretically to the development of a new approach for analyzing IQ of information exchange