Experience with decision support system and comfort with topic predict clinicians’ responses to alerts and reminders

Objective Clinicians at our institution typically respond to about half of the prompts they are given by the clinic’s computer decision support system (CDSS). We sought to examine factors associated with clinician response to CDSS prompts as part of a larger, ongoing quality improvement effort to optimize CDSS use. Methods We examined patient, prompt, and clinician characteristics associated with clinician response to decision support prompts from the Child Health Improvement through Computer Automation (CHICA) system. We asked pediatricians who were nonusers of CHICA to rate decision support topics as “easy” or “not easy” to discuss with patients and their guardians. We analyzed these ratings and data, from July 1, 2009 to January 29, 2013, utilizing a hierarchical regression model, to determine whether factors such as comfort with the prompt topic and the length of the user’s experience with CHICA contribute to user response rates. Results We examined 414 653 prompts from 22 260 patients. The length of time a clinician had been using CHICA was associated with an increase in their prompt response rate. Clinicians were more likely to respond to topics rated as “easy” to discuss. The position of the prompt on the page, clinician gender, and the patient’s age, race/ethnicity, and preferred language were also predictive of prompt response rate. Conclusion This study highlights several factors associated with clinician prompt response rates that could be generalized to other health information technology applications, including the clinician’s length of exposure to the CDSS, the prompt’s position on the page, and the clinician’s comfort with the prompt topic. Incorporating continuous quality improvement efforts when designing and implementing health information technology may ensure that its use is optimized

Pediatric decision support using adapted Arden Syntax

BACKGROUND: Pediatric guidelines based care is often overlooked because of the constraints of a typical office visit and the sheer number of guidelines that may exist for a patient's visit. In response to this problem, in 2004 we developed a pediatric computer based clinical decision support system using Arden Syntax medical logic modules (MLM). METHODS: The Child Health Improvement through Computer Automation system (CHICA) screens patient families in the waiting room and alerts the physician in the exam room. Here we describe adaptation of Arden Syntax to support production and consumption of patient specific tailored documents for every clinical encounter in CHICA and describe the experiments that demonstrate the effectiveness of this system. RESULTS: As of this writing CHICA has served over 44,000 patients at 7 pediatric clinics in our healthcare system in the last decade and its MLMs have been fired 6182,700 times in "produce" and 5334,021 times in "consume" mode. It has run continuously for over 10 years and has been used by 755 physicians, residents, fellows, nurse practitioners, nurses and clinical staff. There are 429 MLMs implemented in CHICA, using the Arden Syntax standard. Studies of CHICA's effectiveness include several published randomized controlled trials. CONCLUSIONS: Our results show that the Arden Syntax standard provided us with an effective way to represent pediatric guidelines for use in routine care. We only required minor modifications to the standard to support our clinical workflow. Additionally, Arden Syntax implementation in CHICA facilitated the study of many pediatric guidelines in real clinical environments

Associations between early exposure to intimate partner violence, parental depression and subsequent mental health outcomes

Objective: To examine the association between parent reports of intimate partner violence (IPV) and depressive symptoms within the first 3 years of a child’s life with subsequent mental health conditions and psychotropic drug treatment. Design: Prospective cohort study linking parental IPV and depression with subsequent billing and pharmacy data. Setting: 4 pediatric clinics between November 2004 and June 2012 Patients/Participants: 2,422 children Main Exposure: Any report of IPV and/or parental depressive symptoms from birth to 3 years of age. Main Outcome Measures: ICD-9 mental health diagnoses and any psychotropic drug treatment between 3 and 6 years of age. Results: 2.4% of caregivers (n=58) reported both IPV and depressive symptoms before their children were 3 years of age, 3% (n=69) of caregivers reported IPV only, 29% (n=704) reported depressive symptoms only, and 65.7% (n=1,591) reported neither exposure. Children of parents reporting both IPV and depressive symptoms were more likely to have a diagnosis of attention deficit hyperactivity disorder (ADHD) (AOR 4.0; 95% CI: 1.5-10.9), even after adjusting for child gender, race/ethnicity, and insurance type. Children whose parents reported depressive symptoms were more likely to have been prescribed psychotropic medication (AOR 1.9; 95% CI: 1.0-3.4). Conclusions: Exposure to both IPV and depression before 3 years is associated with preschool onset ADHD; and early exposure to parental depression is associated with being prescribed psychotropic medication

Racial/Ethnic differences in the prevalence of anxiety using the Vanderbilt ADHD scale in a diverse community outpatient setting

Objective Pediatric anxiety is prevalent but frequently under-diagnosed compared to other behavioral conditions in primary care practice. Pediatricians routinely screen for attention deficit hyperactivity disorder using the Vanderbilt Rating Scale, which includes a short screen for anxiety. We sought to examine the prevalence of potential anxiety among patients whose parents originally had concerns of disruptive behavior in a diverse setting and examine differences in anxiety across ethnic groups using the Vanderbilt ADHD Diagnostic Rating Scale (VADRS). Methods This was a cross-sectional analysis of medical records data of children between the ages of 5–12 years whose parents had concerns of disruptive behavior and received primary care from May 25, 2010 to January 31, 2014 at 2 pediatric community health clinics in Indianapolis. Results 16% of children whose parents had concerns for disruptive behavior screened positive for anxiety based on the VADRS screen. Hispanic parents were less likely to report symptoms of anxiety (Spanish-speaking: AOR 0.4, 95% CI 0.2 – 0.8; English-speaking: AOR 0.3, 95% CI 0.1 – 0.9) compared to white and black families. Conclusion Anxiety is detected at a lower rate among Hispanic pediatric patients using the VADRS. This may suggest differences in the performance of the VADRS among Spanish speaking families

A PROBABILISTIC APPROACH TO DATA INTEGRATION IN BIOMEDICAL RESEARCH: THE IsBIG EXPERIMENTS

Indiana University-Purdue University Indianapolis (IUPUI)Biomedical research has produced vast amounts of new information in the last decade but has been slow to find its use in clinical applications. Data from disparate sources such as genetic studies and summary data from published literature have been amassed, but there is a significant gap, primarily due to a lack of normative methods, in combining such information for inference and knowledge discovery. In this research using Bayesian Networks (BN), a probabilistic framework is built to address this gap. BN are a relatively new method of representing uncertain relationships among variables using probabilities and graph theory. Despite their computational complexity of inference, BN represent domain knowledge concisely. In this work, strategies using BN have been developed to incorporate a range of available information from both raw data sources and statistical and summary measures in a coherent framework. As an example of this framework, a prototype model (In-silico Bayesian Integration of GWAS or IsBIG) has been developed. IsBIG integrates summary and statistical measures from the NIH catalog of genome wide association studies (GWAS) and the database of human genome variations from the international HapMap project. IsBIG produces a map of disease to disease associations as inferred by genetic linkages in the population. Quantitative evaluation of the IsBIG model shows correlation with empiric results from our Electronic Medical Record (EMR) – The Regenstrief Medical Record System (RMRS). Only a small fraction of disease to disease associations in the population can be explained by the linking of a genetic variation to a disease association as studied in the GWAS. None the less, the model appears to have found novel associations among some diseases that are not described in the literature but are confirmed in our EMR. Thus, in conclusion, our results demonstrate the potential use of a probabilistic modeling approach for combining data from disparate sources for inference and knowledge discovery purposes in biomedical research

Assessing the readiness of public healthcare facilities to adopt health information technology (hit)/e-health: a case study of Komfo Anokye Teaching Hospital, Ghana

Most health information technology (HIT)/e-Health initiatives in developing countries are still in project phases and few have become part of routine healthcare delivery due to the lack of clear implementation roadmap. Ghana has been piloting a number of e-Health initiatives, which have not guaranteed a sustainable implementation of such systems. The objective of this research study was to explore the information technology (IT) readiness of public healthcare institutions (primary, secondary and tertiary) in Ghana to adopt e-Health in order to develop a standard HIT/e-Health readiness assessment model. For a population of 28,678,251 people there are only 2,615 medical doctors on the Ministry of Health’s (MoH) payroll as at 2013 and 1818 public hospitals. Consequently, the doctor to population ratio is extremely low as compared to other developing countries, which falls far below the WHO revised standard of 1:600. Under these circumstances there is evidence in developed countries that adoption of health informatics technologies can contribute to improving the situation. An extensive review of literature on e-health in developing countries has identified a general lack of adoption due to a lack of readiness to incorporate the technology into the healthcare environment. Literature provides myriad but fragmented models/frameworks of health information technology (HIT)/e-Health adoption readiness assessment limited measuring tools to assess factors of HIT readiness. This risks the outcomes of HIT/e-Health readiness assessment, which eventually limits knowledge about the strategic gaps warranting the need for the implementation of HIT/e-Health systems in public healthcare institutions in Ghana. Whiles previous studies acknowledge the existence of HIT readiness assessment factors, there exist very limited measuring items for these factors. Simply put, there is not just limited studies on HIT readiness assessment, but there is also no standard guiding readiness assessment model. This study has identified the lack of standard assessment model/framework as well as their accompanying measuring tools for effective outcomes as major gaps. Thus, there was the need for gaining a deeper understanding of existing readiness factors and their applicability in the context of the readiness of public healthcare facilities in Ghana and how they promote or impede HIT/e-Health adoption in order to develop standard HIT readiness assessment model, which comprises readiness factors and most importantly their measuring tools. This study used a mixed method approach, specifically the exploratory sequential design (the exploratory design) where the outcome of qualitative data collected from 13 senior health CIOs and leaders of e-Health initiatives in Ghana analysed built to quantitative data collection instrument. The survey instrument was used to collect quantitative data from 298 clinical and non-clinical staff (Administration/Management leadership) Komfo Anokye Teaching Hospital (KATH) in a form of case study to confirm the findings of the initial exploratory study. This was because the mixed method is rooted in the pragmatism of philosophical assumptions, which guide the direction of the collection and analysis of data and the mixture of qualitative and quantitative approaches in many phases of the research process. Furthermore, mixed research methods design strategy provides a powerful mechanism for IS researchers in dealing with the rapidly changing environment of ICT. An initial standard regression analysis using IBM SPSS version 23 established that five factors (Technology readiness (TR); Operational resource readiness (ORR); Organizational cultural readiness (OCR); Regulatory policy readiness (RPR); and Core readiness (CR)) and 63 indicators (measuring tools) promote and/or impede HIT/e-Health adoption readiness in public healthcare facilities in Ghana. Consequently, these factors were used in developing a standard HIT readiness assessment model. Whiles these five factors all proved to have strong association with the dependent variable Health Information Technology readiness (HITR) in the standard regression, (R2 = 0.971) the findings of a latter PLS-SEM, an advanced regression analysis deployed suggest that Regulatory policy readiness (RPR) and remarkably Core readiness (CR) did not impact on the readiness of KATH to adopt e-Health/HIT. As many public healthcare organizations in Ghana have already begun the process of implementing various HIT/e-Health systems without any reliable HIT/e-Health regulatory policy in place, there is a critical need for reliable HIT/e-Health regulatory policies (RPR) and some improvement in HIT/e-Health strategic planning (core readiness). The final model (R2 = 0.558 and Q2= 0.378) suggest that TR, ORR, and OCR explained 55.8% of the total amount of variance in health information technology/e-Health readiness in the case of KATH, partially supporting the hypotheses of this study. Although no formal hypotheses were proposed for the relationships/effects, which exist between exogenous/independent constructs in the model structure, the SmartPLS3 model path analysis did show that there exist such relationships. For instance, the significant paths from regulatory policy readiness (RPR) to organizational resource readiness (ORR) (t = 23.891; Beta = 0.774) and from technological readiness (TR) to operational resource readiness (ORR) (t = 11.667; Beta = 0.624) obtained from SmartPLS3 bootstrap procedure indicate the presence of mediation. Fit values (SRMR = 0.054; NFI = 0.739). Generally, the GoF for this SEM are encouraging and can substantially be improved when public healthcare facilities in Ghana intending to implement HIT/e-Health pay equal attention to relevant regulatory policies and strategic planning. The readiness assessment model developed this study essentially offers a useful basis for healthcare organizations to enhance the conditions under which HIT/eHealth is launched in order to achieve successful and sustainable adoption with particularly attention being paid to HIT/e-Health regulatory policies and strategic planning. When evaluations such as this are carried out effectively, there could be a circumvention of large losses in money effort and time, delays and disappointments among planners, staff and users of services whiles facilitating the process of change in the institutions and communities involved. This study was conducted with selected subjects and selected public healthcare facilities in the southern cities/parts of Ghana. Therefore, a replication or transfer of this study to other parts of Ghana especially the rural areas and the private healthcare environment should consider the potential differences resulting from varying cultural, socioeconomic and political backgrounds since healthcare is a much-institutionalised industry. The same caution must be exercise when replicating this study in other developing countries and across the globe

Assessing the readiness of public healthcare facilities to adopt health information technology (hit)/e-health: a case study of Komfo Anokye Teaching Hospital, Ghana

Most health information technology (HIT)/e-Health initiatives in developing countries are still in project phases and few have become part of routine healthcare delivery due to the lack of clear implementation roadmap. Ghana has been piloting a number of e-Health initiatives, which have not guaranteed a sustainable implementation of such systems. The objective of this research study was to explore the information technology (IT) readiness of public healthcare institutions (primary, secondary and tertiary) in Ghana to adopt e-Health in order to develop a standard HIT/e-Health readiness assessment model. For a population of 28,678,251 people there are only 2,615 medical doctors on the Ministry of Health’s (MoH) payroll as at 2013 and 1818 public hospitals. Consequently, the doctor to population ratio is extremely low as compared to other developing countries, which falls far below the WHO revised standard of 1:600. Under these circumstances there is evidence in developed countries that adoption of health informatics technologies can contribute to improving the situation. An extensive review of literature on e-health in developing countries has identified a general lack of adoption due to a lack of readiness to incorporate the technology into the healthcare environment. Literature provides myriad but fragmented models/frameworks of health information technology (HIT)/e-Health adoption readiness assessment limited measuring tools to assess factors of HIT readiness. This risks the outcomes of HIT/e-Health readiness assessment, which eventually limits knowledge about the strategic gaps warranting the need for the implementation of HIT/e-Health systems in public healthcare institutions in Ghana. Whiles previous studies acknowledge the existence of HIT readiness assessment factors, there exist very limited measuring items for these factors. Simply put, there is not just limited studies on HIT readiness assessment, but there is also no standard guiding readiness assessment model. This study has identified the lack of standard assessment model/framework as well as their accompanying measuring tools for effective outcomes as major gaps. Thus, there was the need for gaining a deeper understanding of existing readiness factors and their applicability in the context of the readiness of public healthcare facilities in Ghana and how they promote or impede HIT/e-Health adoption in order to develop standard HIT readiness assessment model, which comprises readiness factors and most importantly their measuring tools. This study used a mixed method approach, specifically the exploratory sequential design (the exploratory design) where the outcome of qualitative data collected from 13 senior health CIOs and leaders of e-Health initiatives in Ghana analysed built to quantitative data collection instrument. The survey instrument was used to collect quantitative data from 298 clinical and non-clinical staff (Administration/Management leadership) Komfo Anokye Teaching Hospital (KATH) in a form of case study to confirm the findings of the initial exploratory study. This was because the mixed method is rooted in the pragmatism of philosophical assumptions, which guide the direction of the collection and analysis of data and the mixture of qualitative and quantitative approaches in many phases of the research process. Furthermore, mixed research methods design strategy provides a powerful mechanism for IS researchers in dealing with the rapidly changing environment of ICT. An initial standard regression analysis using IBM SPSS version 23 established that five factors (Technology readiness (TR); Operational resource readiness (ORR); Organizational cultural readiness (OCR); Regulatory policy readiness (RPR); and Core readiness (CR)) and 63 indicators (measuring tools) promote and/or impede HIT/e-Health adoption readiness in public healthcare facilities in Ghana. Consequently, these factors were used in developing a standard HIT readiness assessment model. Whiles these five factors all proved to have strong association with the dependent variable Health Information Technology readiness (HITR) in the standard regression, (R2 = 0.971) the findings of a latter PLS-SEM, an advanced regression analysis deployed suggest that Regulatory policy readiness (RPR) and remarkably Core readiness (CR) did not impact on the readiness of KATH to adopt e-Health/HIT. As many public healthcare organizations in Ghana have already begun the process of implementing various HIT/e-Health systems without any reliable HIT/e-Health regulatory policy in place, there is a critical need for reliable HIT/e-Health regulatory policies (RPR) and some improvement in HIT/e-Health strategic planning (core readiness). The final model (R2 = 0.558 and Q2= 0.378) suggest that TR, ORR, and OCR explained 55.8% of the total amount of variance in health information technology/e-Health readiness in the case of KATH, partially supporting the hypotheses of this study. Although no formal hypotheses were proposed for the relationships/effects, which exist between exogenous/independent constructs in the model structure, the SmartPLS3 model path analysis did show that there exist such relationships. For instance, the significant paths from regulatory policy readiness (RPR) to organizational resource readiness (ORR) (t = 23.891; Beta = 0.774) and from technological readiness (TR) to operational resource readiness (ORR) (t = 11.667; Beta = 0.624) obtained from SmartPLS3 bootstrap procedure indicate the presence of mediation. Fit values (SRMR = 0.054; NFI = 0.739). Generally, the GoF for this SEM are encouraging and can substantially be improved when public healthcare facilities in Ghana intending to implement HIT/e-Health pay equal attention to relevant regulatory policies and strategic planning. The readiness assessment model developed this study essentially offers a useful basis for healthcare organizations to enhance the conditions under which HIT/eHealth is launched in order to achieve successful and sustainable adoption with particularly attention being paid to HIT/e-Health regulatory policies and strategic planning. When evaluations such as this are carried out effectively, there could be a circumvention of large losses in money effort and time, delays and disappointments among planners, staff and users of services whiles facilitating the process of change in the institutions and communities involved. This study was conducted with selected subjects and selected public healthcare facilities in the southern cities/parts of Ghana. Therefore, a replication or transfer of this study to other parts of Ghana especially the rural areas and the private healthcare environment should consider the potential differences resulting from varying cultural, socioeconomic and political backgrounds since healthcare is a much-institutionalised industry. The same caution must be exercise when replicating this study in other developing countries and across the globe