A Lazy User Perspective to the Voluntary Adoption of Electronic Personal Health Records (PHRs)

Personal Health Records (PHRs) have been imbued with the potential to improve health outcomes for individual healthcare consumers, providers, and the broader healthcare system. With Meaningful Use Stage 2 now mandating the implementation of tethered PHRs, tethered to provider electronic health records (patient portals), will healthcare consumers voluntarily use PHRs and contribute to safety, quality, efficiency and reduced health disparities through engagement? Or will PHR use remain low? In this qualitative study, using grounded theory, we asked users how they currently managed their personal health information (PHI) and why. Using the lazy user model, we found that letting physicians manage healthcare consumers PHI is the least effort-based solution and thus the predominant and preferred solution. Providers as guardians of patient PHI suggests the low use rates may persist yet. We should do more to make these technologies usable and accessible to those with irregular contact with a primary care physician

Healthcare Consumers’ Voluntary Adoption and Non-Adoption of Electronic Personal Health Records

The use and ready availability of electronic health records is broadly purported to have the potential to improve health outcomes for individual healthcare consumers, providers and the healthcare system as a whole. Unlike electronic health records that are created and managed by providers, personal health records (PHR) are controlled by the individual consumer and the persons/entities to which they choose to grant access. Studies show while more healthcare consumers have access to PHRs, their voluntary adoption is lagging. Yet, our understanding of adoption lag is also lacking. In this qualitative study, we investigate: (1) how individual healthcare users in Connecticut currently manage their personal health information, (2) whether they have adopted an electronic PHR and the considerations that influenced the volitional adoption or non-adoption of a PHR. Initial findings casts new and surprising understandings including how healthcare consumers would like to use PHRs

The Role of Negotiation in Privacy-Enhanced E-Commerce Transactions

Online vendors use personal information to deliver customized services efficiently to their customers. Both users and vendors value the relationship building made possible using personal data. However, the use of personally identifying data gives rise to the potential for privacy invasion. When consumers must disclose personal information, they are forced to perform a risk-benefit analysis in which the risks of disclosing one\u27s personal information are weighted against the potential benefits of the disclosure. While some researchers note that consumers maximize benefits in deciding whether to disclose personal information, others argue that consumers lack sufficient information and power to make educated, balanced decisions regarding disclosing their private information. We add to the privacy discussion by arguing that a real negotiation position for both parties can help realize the full benefits of online personalization. We propose a model for mitigating the tension between the benefits of personalization and the risks to privacy invasion. This framework informs our future work which seeks to develop rich and deep understandings of negotiated, privacy-concerned personalization

Healthcare Consumers’ Voluntary Adoption and Non- Adoption of Electronic Personal Health Records

Abstract: The use and ready availability of electronic health records is broadly purported to have the potential to improve health outcomes for individual healthcare consumers, providers and the healthcare system as a whole. Unlike electronic health records that are created and managed by providers, personal health records (PHR) are controlled by the individual consumer and the persons/entities to which they choose to grant access. Studies show while more healthcare consumers have access to PHRs, their voluntary adoption is lagging. Yet, our understanding of adoption lag is also lacking. In this qualitative study, we investigate: (1) how individual healthcare users in Connecticut currently manage their personal health information, (2) whether they have adopted an electronic PHR and the considerations that influenced the volitional adoption or non-adoption of a PHR. Initial findings casts new and surprising understandings including how healthcare consumers would like to use PHRs

A Framework for Examining the Building of ICT Capacity in Developing Nations: Role of Cultural and Institution

Information and communication technologies (ICTs) have been acknowledged as key to the economic and social development of developing nations. There are divergent views on the importance of ICT development for developing nations. Those who oppose ICT expansion argue that developing nations should use scarce resources in building roads, education and medical facilities rather than ICT. Thus the building of a nation’s ICT capacity would be influenced by several institutions. However, prior research has focused predominantly on how governmental institutions influence the building of ICT capacity. In this paper we propose a framework for examining the building of ICT capacity in developing nations that has four major components: institutional entities, institutional interventions, culture and environmental factors. We present some theoretical propositions that can be used to test our proposed framework. While the list of entities and propositions is not exhaustive, we believe that this work provides a useful initial roadmap to understanding the impact of the interplay between culture and institutional factors on the building of ICT capacity in developing nations

Quantitation of ischemic events after severe traumatic brain injury in humans: a simple scoring system

Cerebral ischemia is recognized as one of the most important mechanisms responsible for secondary brain damage following severe traumatic brain injury (TBI), contributing to an increased mortality and a worse neurologic outcome. A simple 5-item scoring system, taking into account the occurrence of specific potentially brain-damaging events (hypoxemia, hypotension, low cerebral blood flow, herniation, and low cerebral perfusion pressure) has been tested in a large population of severe TBI patients. Aims of this retrospective study were to validate the ability of the proposed ischemic score to predict neurologic outcome and to correlate the ischemic score with the results of microdialysis-based neurochemical monitoring and brain tissue oxygen monitoring. In a population of 172 severe TBI patients, a significant correlation was found between ischemic score and neurologic outcome, both at 3 months (r = -0.32; P < 0.01) and at 6 months (r = -0.31; P < 0.01). Significant correlations were also found with the most important neurochemical analytes. The ischemic score proposed here, may be determined during the acute intensive care unit period, and correlates closely with outcome, which can only be determined 3 to 6 months, after injury. It also shows a correlation with neurochemical analytes

Brain metabolic and hemodynamic effects of cyclosporin A after human severe traumatic brain injury: a microdialysis study

Mitochondrial dysfunction is a major limiting factor in neuronal recovery following traumatic brain injury. Cyclosporin A (CsA) has been recently proposed for use in the early phase after severe head injury, for its ability to preserve mitochondrial bioenergetic state, potentially exerting a neuroprotective effect. The aim of this study was, therefore, to evaluate the effect of CsA on brain energy metabolism, as measured by cerebral microdialysis, and on cerebral hemodynamics, in a group of severely head injured patients.Fifty adult patients with a severe head injury were enrolled in this randomized, double-blind, placebo-controlled study. Patients received 5 mg/kg of CsA over 24 h, or placebo, within 12 h of the injury. A microdialysis probe was placed in all patients, who were managed according to standard protocols for the treatment of severe head injury.The most robust result of this study was that, over most of the monitoring period, brain dialysate glucose was significantly higher in the CsA treated patients than in placebo. Both lactate and pyruvate were also significantly higher in the CsA group. Glutamate concentration and lactate/pyruvate ratio were significantly higher in the placebo group than in CsA treated patients, respectively 1 to 2 days, and 2 to 3 days after the end of the 24-h drug infusion. The administration of CsA was also associated with a significant increase in mean arterial pressure (MAP) and cerebral perfusion pressure (CPP).The administration of CsA in the early phase after head injury resulted in significantly higher extracellular fluid glucose and pyruvate, which may be evidence of a beneficial effect. The early administration of CsA was also associated with a significant increase in MAP and CPP and such a potentially beneficial hemodynamic effect might contribute to a neuroprotective effect