Regional Integration: Physician Perceptions on Electronic Medical Record Use and Impact in South West Ontario

Regional initiatives in the health care context in Canada are typically organized and administered along geographic boundaries or operational units. Regional integration of Electronic Medical Records (EMR) has been continuing across Canadian provinces in recent years, yet the use and impact of regionally integrated EMRs are not routinely assessed and questions remain about their impact on and use in physicians’ practices. Are stated goals of simplifying connections and sharing of electronic health information collected and managed by many health services providers being met? What are physicians’ perspectives on the use and impact of regionally integrated EMR? In this thesis, I examined how primary health care and family physicians use electronic medical records and associated electronic health information resources in South West Ontario, the challenges they face in doing so, as well as the impact of an integrated EMR. A mixed methods-grounded theory research approach was employed to explore physician EMR use, and data acquired using participant consultation, observership and shadowing, semi-structured interviews, and a self-administered questionnaire. The study revealed that there are clear and present challenges to regional integration of EMR. Although regional integration initiatives such as implementation of ClinicalConnect, a regional EMR clinical viewer, continue to expand, physicians face challenges related to implementation, support and advanced use of electronic records. Not every patient has data access, patient portals are often not fully integrated, and the impact of EMR transitioning can reshape a primary care physician practice. A comprehensive model of physician integrated EMR use and a six-stage maturity model were developed from this study: The comprehensive model conceptualizes how the experience of EMR transitioning, managing patient expectation, meeting information needs, engaging regional entities, support and practice context, influence physician perception of EMR integration, and often resulted in practice changing moments. It further describes influences on physician perception of EMR use by EMR offering, EMR content, integration tools, information attributes, practice type, and patient and physician characteristics. The six-stage maturity model provides a framework that describes key elements of operative EMR use within the context of regional integration of electronic health information resources. It enhances understanding of EMR maturity by shifting orientation from theoretical evolutionary improvement path, which characterized prior maturity models, to assessment of EMR maturity based on how practicing physicians actually use EMR in primary health care. Insights from this study will advance understanding of regional integration of electronic medical records and serve as additional resource for individuals interested in assessment of the use and impact of electronic health information resources in primary health care

INFORMATION AND COMMUNICATION TECHNOLOGIES (ICTs) IN THE SERVICES OF HEALTHCARE SECTOR IN EUROPE

Information and Communication Technologies (ICTs) consists of all technical means used to handle information and aid communication, including both computer and network hardware as well as necessary software. Information and Communication Technologies tools and services are used in many sectors like development, education, e-services, policy, health and medicine and so one. This paper links the ICTs tools and services for health. ICTs has the potential to impact almost every aspect of the health sector. Information and Communication Technologies (ICTs) have an important role in service engineering, improving medical knowledge and practice, and defining new fields of research.eHealth, healthcare sector, telemedicine services, health portals, health information networks, digital health infrastructure

EHR Patient Portal Usage in Portugal

Promoting the use of EHR Patient Portals is becoming more relevant for our society. With the increased usage of digital services to the consumers, the healthcare systems are one of the areas that demand more growth in their usage. With an increasingly older population and less healthcare resources available, the use of eHealth tools could play a critical role in the future sustainability of healthcare systems. We did a national survey, in Portugal, based on randomly generated mobile phone numbers and 8.6% of the responders mentioned that they are users of EHR Patient Portals. We also collected the usage patterns and socio-demographic information about healthcare consumers that use EHR Patient Portals. Compared with the Portuguese population they are younger, more educated and have a higher proportion of private health insurances

Credibility of Health Information and Digital Media: New Perspectives and Implications for Youth

Part of the Volume on Digital Media, Youth, and Credibility. This chapter considers the role of Web technologies on the availability and consumption of health information. It argues that young people are largely unfamiliar with trusted health sources online, making credibility particularly germane when considering this type of information. The author suggests that networked digital media allow for humans and technologies act as "apomediaries" that can be used to steer consumers to high quality health information, thereby empowering health information seekers of all ages

Using governance to understand how to improve an SME’s success with introducing ehealth applications in Dutch healthcare organisations

The Hanze University of Applied Science can combine its expertise in the field of ICT with knowledge of communication and knowledge game design and user experience to contribute to the effective communication on ehealth applications by researching communication patterns and developing communication means

Early Adoption of Patient Portals by U.S. Hospitals

Customer-facing information systems have received very little research attention, especially in the context of healthcare. Ashospitals begin to provide healthcare consumers with online patient portals to view and manage personal health records anddiagnostic results, little is known about whether or not the ‘dominant paradigm’ (Fichman 2004) of diffusion of innovationstheory is sufficient for explaining the characteristics of early adopters. We suggest that a more nuanced understanding ofearly adoption of patient portals is needed because early adopters are not only the largest hospitals with substantial resourcesand capabilities residing within competitive environments. Specifically, we suggest that patient-portals are impacted bymarket characteristics and require Electronic Medical Records (EMRs) systems to be adopted first. We develop a non-linear,two-stage, econometric model with sample selection correction that controls for EMR adoption and estimates the impact ofdiffusion of innovation and market characteristics on the early adoption of patient portals by U.S. hospitals

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

Good practices for clinical data warehouse implementation: a case study in France

Real World Data (RWD) bears great promises to improve the quality of care. However, specific infrastructures and methodologies are required to derive robust knowledge and brings innovations to the patient. Drawing upon the national case study of the 32 French regional and university hospitals governance, we highlight key aspects of modern Clinical Data Warehouses (CDWs): governance, transparency, types of data, data reuse, technical tools, documentation and data quality control processes. Semi-structured interviews as well as a review of reported studies on French CDWs were conducted in a semi-structured manner from March to November 2022. Out of 32 regional and university hospitals in France, 14 have a CDW in production, 5 are experimenting, 5 have a prospective CDW project, 8 did not have any CDW project at the time of writing. The implementation of CDW in France dates from 2011 and accelerated in the late 2020. From this case study, we draw some general guidelines for CDWs. The actual orientation of CDWs towards research requires efforts in governance stabilization, standardization of data schema and development in data quality and data documentation. Particular attention must be paid to the sustainability of the warehouse teams and to the multi-level governance. The transparency of the studies and the tools of transformation of the data must improve to allow successful multi-centric data reuses as well as innovations in routine care.Comment: 16 page

Health information technology (HIT) in small and medium sized physician practices: examination of impacts and HIT maturity

Small and medium sized physician practices (SMPP) are medical practices that consist of a staff of less than 10 physicians. Nearly 60% of the US physicians work in SMPP and face more barriers to HIT adoption and implementation than their larger counterparts. The dissertation is on the use and impact of Health Information Technology (HIT) on SMPP. The dissertation will also explore the effects of IT maturity on health care organizations’ abilities to impact outcomes. It will examine how SMPP have grown through the use of IT and how this has impacted the organization’s use of HIT. While previous work has observed some organizational impacts of HIT, they have only studied a single phenomenon that had been impacted and not how the organization as a whole is impacted. While researchers have found that organizations with higher IT maturity tend to show better operational and financial performance, very little prior studies have shown the impact of HIT maturity on SMPP. The dissertation’s goal is to answer the following questions: 1. How does HIT usage influence the organizational impacts on Small and Medium Sized Physician Practices? 2. How does the SMPP’s HIT maturity influence these impacts? To answer these questions, the dissertation used a framework derived from DeLone and McLean’s (1992, 2003) IS Success Model and the IT Value Hierarchy (Urwiler & Frolick, 2008). The dissertation employed a multiple case study approach by collecting and analyzing data from various members of five different SMPP. The dissertation found that the process of HIT documentation had a major influence on the SMPP. While it has a positive impact on the patient’s Quality of Care, it has a negative impact on Productivity and User Satisfaction. While prior HIT research found that communication was a final outcome of HIT use, this dissertation found that communication is a mitigating factor influencing organizational impacts