On the Cusp of Change: Health Information Technology in the United States, 2009

Examines the state of electronic health records (EHR) adoption in U.S. hospitals generally and in safety-net hospitals, changes in state and federal policies, links between EHR adoption and quality metrics, and implications for healthcare disparities

Health Information Technology in the United States: On the Cusp of Change, 2009

In this report we use the data collected for ONCHIT to focus on EHR adoption in the inpatient setting. We report on several important policy issues. These include the rate of adoption of EHRs among U.S. hospitals generally and among safety-net hospitals, changes in both state and federal policy, and the potential of EHRs to change the quality measurement enterprise

India and the United Kingdom—What big data health research can do for a country

INTRODUCTION: Big data and growth in telecommunications have increased the enormous promise of an informatics approach to health care. India and the United Kingdom are two countries facing these challenges of implementing learning health systems and big data health research. ANALYSIS: At present, these opportunities are more likely to be exploited in the private sector or in public‐private partnerships (eg, Public Health Foundation of India [PHFI]) than public sector ventures alone. In both India and the United Kingdom, the importance of health informatics (HIs), a relatively new discipline, is being recognised and there are national initiatives in academic and health sectors to fill gaps in big data health research. The challenges are in many ways greater in India but outweighed by three potential benefits in health‐related scientific research: (a) increased productivity; (b) a learning health system with better use of data and better health outcomes; and (c) to fill workforce gaps in both research and practice. CONCLUSIONS: Despite several system‐level obstacles, in India, big data research in health care can improve the status quo, whether in terms of patient outcomes or scientific discovery. Collaboration between India and the United Kingdom in HI can result in mutual benefits to academic and health care delivery organisations in both countries and can serve as examples to other countries embracing the promises and the pitfalls of health care research in the digital era

The adoption of ICT in Malaysian public hospitals: the interoperability of electronic health records and health information systems

There have been a number of researches that investigated ICT adoption in Malaysian healthcare. With the small number of hospitals that adopt ICT in their daily clinical and administrative operations, the possibility to enable data exchange across 131 public hospitals in Malaysia is still a long journey. In addition to those studies, this research was framed under six objectives, which aim to critically review existing literature on the subject matter, identify barriers of ICT adoption in Malaysia, understand the administrative context during the pre and post-ICT adoption, and recommend possible solutions to the Ministry of Health of Malaysia (MoHM) in its efforts to implement interoperable electronic health records (EHR) and health information systems (HTIS). Specifically, this research aimed to identify the factors that had significant impacts to the processes of implementing interoperable EHR and HTIS by the MoHM. Furthermore, it also aimed to propose relevant actors who should involve in the implementation phases. These factors and actors were used to develop a model for implementing interoperable EHR and HTIS in Malaysia. To gather the needed data, series of interviews were conducted with three groups of participants. They were ICT administrators of MoHM, ICT and medical record administrators of three hospitals, and physicians of three hospitals. To ensure the interview feedback was representing the context of EHR and HTIS implementation in Malaysia, two hospital categories were selected, which included the hospitals with HTIS and non-HTIS hospitals. The government documents were then used to triangulate the feedback to ensure dependability, credibility, transferability and conformity of the findings. Two techniques were used to analyse the data, which were thematic analysis and theme matching. These two techniques were modified from its original method, known as pattern matching. The originality of this research was presented in the findings and methods to transform them into solutions and provide recommendation to the MoHM. In general, the results showed that the technological factors contributed less to the success of the implementation of interoperable EHR and HTIS compared to the managerial and administrative factors. Four main practical and social contributions were identified from this research, which included synchronisation of managerial elements, political determination and change management transformation, optimisation of use of existing legacy system (Patient Management System) and finally the roles of actors. Nevertheless, the findings of this research would be more dependable and transferable if more participants had been willing to participate especially among the physicians and those who managed the ICT adoptions under the MoHM

An Integrative Review of the Literature on Technology Transformation in Healthcare

Healthcare transformation through technology is a core objective of health reform. It is important for decision makers to understand the likelihood that reform policies will in fact transform. This study evaluates evidence of technology transformation in healthcare through an integrative review of the healthcare and business literature, guided by the theory of punctuated equilibrium (TPE). TPE describes the process of transformation within organizations, markets, and groups. The theory explains transformation as a pattern of long periods of incremental change (equilibrium) punctuated by short periods of dramatic change (revolution). An underlying deep structure defines the environment of the organization, market, or group. Radical change in the deep structure of the environment is necessary for transformational change. This integrative review covered the period January 2004 through April 2012. The inclusion criteria required that the article or study address both the implementation of health information technology in the United States and describe one of the three components of TPE. Five hundred twenty articles focusing on transformational change were identified through structured database searches of MedLine/PubMed, Business Source Complete, Social Science Research Network, and others. The articles were reviewed, and coded using the three elements of TPE. A directed content analysis of the coded data produced 10 themes describing the three TPE elements: variations in the environment, market complexity, regulation, flawed risk and reward, theories of technology acceptance, barriers, ethical considerations, competition and sustainability, environmental elements of revolution, and internal elements of revolution. The results describe a healthcare market exhibiting strong equilibrium and substantial resistance to change from HIT. Minimal descriptions of the revolutionary element of TPE were evident. The deep structure of healthcare indicates that the historical provider and hospital-centered market prevails. Conditions that might encourage alteration of this deep structure were: empowering and engaging patients; updating care delivery models; and reducing market uncertainty. The revolutionary changes seen in other complex markets from banking to travel to manufacturing relied heavily on the power of the consumer to alter deep structure. Although the concept of patient centeredness was present in the literature there was little clarity regarding the patient as an agent of structural change. To our knowledge this is the first application of TPE to investigate technology transformation in healthcare. Others have demonstrated TPE as a viable model for explaining transformational change in other markets. The study is limited by the study timeframe and the absence of newer literature reflecting the impact of recent policy changes. Despite this limitation the findings suggest that TPE presents a potentially valuable framework to guide evaluation of the progress of policies that encourage transformation from technology. Some propose that altering the complex deep structure of healthcare may require a complete destruction of existing processes before new processes, innovations, and technologies can emerge. The Affordable Care Act (2010) and the meaningful use provisions of the HITECH Act (2009) are moving healthcare toward new patient centered models of care. Uncertainty around the future of reform policies from possible repeal or amendment likely contributes to resistance to transformational change. This may perpetuate the historical rational and incremental pattern of HIT advancement. Patients as consumers have the potential to influence change given the appropriate tools. The importance of consumers to the transformation process suggests that policies fostering technologies that integrate patients into new care delivery models are likely paramount to realizing technological transformation

Moving Towards a Social-Health Information Exchange: Analyzing the Health IT Systems Necessary for Holistic Healthcare

Health information technology has the potential to transform the healthcare industry with a robust health information exchange. This paper examines what data is to be recorded and shared, with whom is the data to be shared, who is to have access to the data, who gets to decide all of this? Recent studies suggest that the recent deluge of big data require interdisciplinary efforts moving forward. Analysis of semi-structured interviews with a variety of stakeholders throughout the industry revealed frustration with the current systems and optimism about the future. Results revealed that all parties are willing and eager to be a part of the growing conversation, though the majority do not feel included. All participants favorably discussed the potential for health IT to positively influence healthcare if certain considerations are taken into account. Primary barriers to implementation, privacy, financial, data collection, and stakeholder buy-in, were consistent with previous research.Master of Science in Information Scienc

Health Information Technology in the United States, 2008

Provides updated survey data on health information technology (HIT) and electronic health records adoption, with a focus on providers serving vulnerable populations. Examines assessments of HIT's effect on the cost and quality of care and emerging issues

Issues of the adoption of HIT related standards at the decision-making stage of six tertiary healthcare organisations in Saudi Arabia

Due to interoperability barriers between clinical information systems, healthcare organisations are facing potential limitations with regard to acquiring the benefits such systems offer; in particular, in terms of reducing the cost of medical services. However, to achieve the level of interoperability required to reduce these problems, a high degree of consensus is required regarding health data standards. Although such standards essentially constitute a solution to the interoperability barriers mentioned above, the level of adoption of these standards remains frustratingly low. One reason for this is that health data standards are an authoritative field in which marketplace mechanisms do not work owing to the fact that health data standards developed for a particular market cannot, in general, be applied in other markets without modification. Many countries have launched national initiatives to develop and promote national health data standards but, although certain authors have mapped the landscape of the standardisation process for health data in some countries, these studies have failed to explain why the healthcare organisations seem unwilling to adopt those standards. In addressing this gap in the literature, a conceptual model of the adoption process of HIT related standards at the decision-making stage in healthcare organisations is proposed in this research. This model was based on two predominant theories regarding IT related standards in the IS field: Rogers paradigm (1995) and the economics of standards theory. In addition, the twenty one constructs of this model resulted from a comprehensive set of factors derived from the related literature; these were then grouped in accordance with the Technology-Organisation Environment (TOE), a well-known taxonomy within innovation adoption studies in the IS field. Moving from a conceptual to an empirical position, an interpretive, exploratory, multiple-case study methodology was conducted in Saudi Arabia to examine the proposed model. The empirical qualitative evidence gained necessitated some revision to be made to the proposed model. One factor was abandoned, four were modified and eight new factors were added. This consistent empirical model makes a novel contribution at two levels. First, with regard to the body of knowledge in the IS area, this model offers an in-depth understanding of the adoption process of HIT related standards which the literature still lacks. It also examines the applicability of IS theories in a new area which allows others to relate their experiences to those reported. Secondly, this model can be used by decision makers in the healthcare sector, particularly those in developing countries, as a guideline while planning for the adoption of health data standards

Improving Local Public Health Capacity Through a Health Information Exchange in South Texas: Policy Implications for Health Leaders

Three out of four deaths in the state of Texas are caused by chronic diseases with hospital discharges in 2008 alone costing more than $10 billion. Chronic disease surveillance systems are needed for the identification and tracking of diseases in order to target prevention and treatment activities. However, the IOM has reported inconsistencies in surveillance of chronic illnesses caused by a lack of standardized methods for measuring complex attributes and determinants of health along with insufficient public health system resources to perform this function. The use of health information exchanges (HIE) offer important new and rich potential data sources for public health to improve our ability to monitor and track chronic diseases. But the ability of public health agencies to manage and act on these new electronic data streams has been identified as a challenge due to their limited current capacities. This study aimed to understand the challenges in using HIE for community level surveillance of chronic diseases and reviewed the capacity of public health departments participating in a Corpus Christi based HIE, Health Information Network of South Texas (HINSTX). The study used a qualitative approach that combined a survey of health departments and semi-structured key informant interviews of health department, state, and national officials to supplement and provide context for survey data. Three key themes were identified: need for skilled staff; clearly articulated regulations to enable effective use of HIE; and development of an integrated public health IT strategy. Recommendations included, personnel capacity development, inter-organizational informatics collaboration, interim legal bridge for using HIE for public health surveillance and health department enterprise architecture plan development.Doctor of Public Healt

Designing and executing digital strategies : completed research paper

The digital economy poses existential threats to — and game-changing opportunities for — companies that were successful in the pre-digital economy. What will distinguish those companies that successfully transform from those that become historical footnotes? This is the question a group of six researchers and consultants from Boston Consulting Group set out to examine. The team conducted in-depth interviews with senior executives at twenty-seven companies in different industries to explore the strategies and organizational initiatives they relied on to seize the opportunities associated with new, readily accessible digital technologies. This paper summarizes findings from this research and offers recommendations to business leaders responsible for digital business success