Methodological reflections on the evaluation of the implementation and adoption of national electronic health record systems

Copyright @ 2012, International Journal of Integrated Care (IJIC). This work is licensed under a (http://creativecommons.org/licenses/by/3.0) Creative Commons Attribution 3.0 Unported License.Introduction/purpose of presentation: Far-reaching policy commitments to information technology-centered transformations of healthcare systems have now been made in many countries. There is as yet little empirical evidence to justify such decisions, hence the need for rigorous independent evaluation of current implementation efforts. Such evaluations however pose a number of important challenges. This presentation has been designed as a part of a Panel based on our experience of evaluating the National Health Service’s (NHS) implementation of electronic health records (EHR) systems in hospitals throughout England. We discuss the methodological challenges encountered in planning and undertaking an evaluation of a program of this scale and reflect on why and how we adapted our evaluation approach—both conceptually and methodologically—in response to these challenges. Study design/population studied: Critical reflections on a multi-disciplinary and multi-facet independent evaluation of a national program to implement electronic health record systems into 12 ‘early wave’ NHS hospitals in England. Findings: Our initial plan was to employ a mixed methods longitudinal ‘before-during-after’ study design. We however found this unsustainable in the light of fluxes in policy, contractual issues and over-optimistic schedules for EHR deployments. More importantly, this research design failed adequately to address the core of multi-faceted evolving EHRs as understood by key stakeholders and as worked out in their distinct work settings. Thus conventional outcomes-centric evaluations may not easily scale-up when evaluating transformational programs and may indeed prove misleading. New assumptions concerning the implementation process of EHR need to be developed that recognize the constantly changing milieu of policy, product, projects and professions that are inherent to such national implementations. The approaches we subsequently developed substitute the positivist view that EHR initiatives are self-evident and self-contained interventions, which are amenable to traditional quantitative evaluations, to one that focuses on how they are understood by various stakeholders and made to work in specific contexts. These assumptions recast the role of evaluation towards an approach that explores and interprets processes of socio-technical change that surround EHR implementation and adoption as seen by multiple stakeholders. Conclusions and policy implications: There is likely to be an increase in politically-driven national programs of reform of healthcare based on information and communication technologies. Programs on such a scale are inherently complex with extended temporalities and extensive and dynamic sets of stakeholders. They are, in short, different and pose new evaluation challenges that previously formulated evaluation methods for health information systems cannot easily address. This calls for methodological innovation amongst research teams and their supporting bodies. We argue that evaluation of such system-wide transformation programs are likely to demand both breadth and depth of experience within a multidisciplinary research team, constant questioning of what is and what can be evaluated and how, and a particular way of working that emphasizes continuous dialogue and reflexivity. Making this transition is essential to enable evaluations that can usefully inform policy-making. Health policy experts urgently need to reassess the evaluation strategies they employ as they come to address national policies for system-wide transformation based on new electronic health infrastructures

II in generalized supergravity

We showed in previous work that for homogeneous Yang-Baxter (YB) deformations of AdS$_5\times$S$^5$, the open string metric and coupling, and as a result the closed string density $e^{-2 \Phi} \sqrt{g}$, remain undeformed. In this work, in addition to extending these results to the deformation associated with the modified CYBE, or $\eta$-deformation, we identify the Page forms as the open string counterpart for RR fields and demonstrate case by case that the non-zero Page forms remain invariant under YB deformations. We give a physical meaning to the Killing vector $I$ of generalized supergravity and show for all YB deformations: 1) $I$ appears as a current for center of mass motion on the worldvolume of a D-branes probing the background, 2) $I$ is equal to the divergence of the noncommutativity parameter, 3) $I$ exhibits "holographic" behavior, where the radial component of $I$ vanishes at the AdS boundary, and 4) in pure spinor formalism $I$ is related to a certain state in the BRST cohomology.Comment: 11 pages, 2 column; v2 references updated; v3 to appear in EPJ

p-p' System with B-field, Branes at Angles and Noncommutative Geometry

We study the generic $p-p^\prime$ system in the presence of constant NS 2-form $B_{ij}$ field. We derive properties concerning with the noncommutativity of D-brane worldvolume, the Green functions and the spectrum of this system. In the zero slope limit, a large number of light states appear as the lowest excitations in appropriate cases. We are able to relate the energies of the lowest states after the GSO projection with the configurations of branes at angles. Through analytic continuation, the system is compared with the branes with relative motion.Comment: 21 pages, Latex. References regarding to section 3 and 4 added. Typos correcte

Study of diagnostic importance of fine needle aspiration cytology in various body lesions in a predominantly rural mountainous region of Jammu and Kashmir, G.M.C Doda, India

Background: Fine Needle Aspiration Cytology (FNAC) is a procedure of choice as the first line of investigation in diagnosing non-neoplastic and neoplastic swellings of different areas as it has been found to be highly accurate and very useful, cost effective, offer early diagnosis after presentation and  treatment. In this present study in Department of pathology, data was collected and scrutinized. Cytology of various sites including breast, head and neck, salivary glands, thyroid, lymph nodes, etc. was done.Methods: FNAC is performed with the help of 21-22-gauge needle attached with 20 ml syringe by taking all aseptic precautions. Total of 70 cases were collected over a period of 4 months from April 2019 to July 2019.Results: Out of total 70 samples maximum number of cases were found in 21-30 years of age (16 cases); Males were 34(49%) and females were 36(51%) in number. 38 cases (54%) were non-neoplastic ,23 cases (33%) were neoplastic and in 9 cases (13%) no opinion was made. This study included 70 cytologically diagnosed cases. Out of which 38 cases (54%) were non-neoplastic, 23 cases (33%) neoplastic and in 9 cases (13%) no possible opinion could be made due to a number of factors like: Material not corresponding of representative area, small size of lesion, wrong technique, cystic areas, hemorrhage and necrosis and small foci of neoplastic lesion.Conclusions: Even though a number of limitations, FNAC has high accuracy in diagnosing benign and malignant lesions of various sites and thus reduces the period between presentation of tumours and their diagnosis which results in early management

Which way? Direction-Aware Attributed Graph Embedding

Graph embedding algorithms are used to efficiently represent (encode) a graph in a low-dimensional continuous vector space that preserves the most important properties of the graph. One aspect that is often overlooked is whether the graph is directed or not. Most studies ignore the directionality, so as to learn high-quality representations optimized for node classification. On the other hand, studies that capture directionality are usually effective on link prediction but do not perform well on other tasks. This preliminary study presents a novel text-enriched, direction-aware algorithm called DIAGRAM , based on a carefully designed multi-objective model to learn embeddings that preserve the direction of edges, textual features and graph context of nodes. As a result, our algorithm does not have to trade one property for another and jointly learns high-quality representations for multiple network analysis tasks. We empirically show that DIAGRAM significantly outperforms six state-of-the-art baselines, both direction-aware and oblivious ones,on link prediction and network reconstruction experiments using two popular datasets. It also achieves a comparable performance on node classification experiments against these baselines using the same datasets

Policy parameters for optimising hospital ePrescribing:An exploratory literature review of selected countries of the Organisation for Economic Co-operation and Development

OBJECTIVE: Electronic prescribing systems offer considerable opportunities to enhance the safety, effectiveness and efficiency of prescribing and medicines management decisions but, despite considerable investments in health IT infrastructure and healthcare professional training, realising these benefits continues to prove challenging. How systems are customised and configured to achieve optimal functionality is an increasing focus for policymakers. We sought to develop an overview of the policy landscape currently supporting optimisation of hospital ePrescribing systems in economically developed countries with a view to deriving lessons for the United Kingdom (UK). METHODS: We conducted a review of research literature and policy documents pertaining to optimisation of ePrescribing within hospitals across Organisation for Economic Co-operation and Development (OECD) countries on Embase, Medline, National Institute for Health (NIH), Google Scholar databases from 2010 to 2020 and the websites of organisations with international and national health policy interests in digital health and ePrescribing. We designed a typology of policies targeting optimisation of ePrescribing systems that provides an overview of evidence relating to the level at which policy is set, the aims and the barriers encountered in enacting these policies. RESULTS: Our database searches retrieved 11 relevant articles and other web resources mainly from North America and Western Europe. We identified very few countries with a national level strategy for optimisation of ePrescribing in hospitals. There were hotspots of digital maturity in relation to ePrescribing at institutional, specialisation, regional and national levels in the US and Europe. We noted that such countries with digital maturity fostered innovations such as patient involvement. CONCLUSIONS: We found that, whilst helpful to achieve certain aims, coordinated strategies within and across countries for optimisation of ePrescribing systems are rare, even in countries with well-established ePrescribing and digital health infrastructures. There is at present little policy focus on maximising the utility of ePrescribing systems