Users' perspectives of barriers and facilitators to implementing EHR in Canada: A study protocol

<p>Abstract</p> <p>Background</p> <p>In Canada, federal, provincial, and territorial governments are developing an ambitious project to implement an interoperable electronic health record (EHR). Benefits for patients, healthcare professionals, organizations, and the public in general are expected. However, adoption of an interoperable EHR remains an important issue because many previous EHR projects have failed due to the lack of integration into practices and organizations. Furthermore, perceptions of the EHR vary between end-user groups, adding to the complexity of implementing this technology. Our aim is to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators influencing the adoption of an interoperable EHR among its various users and beneficiaries.</p> <p>Methods</p> <p>First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to the implementation of the EHR. Standardized literature search and data extraction methods will be used. Studies' quality and relevance to inform decisions on EHR implementation will be assessed. For each group of EHR users identified, barriers and facilitators will be categorized and compiled using narrative synthesis and meta-analytical techniques. The principal factors identified for each group of EHR users will then be validated for its applicability to various Canadian contexts through a two-round Delphi study, involving representatives from each end-user groups. Continuous exchanges with decision makers and periodic knowledge transfer activities are planned to facilitate the dissemination and utilization of research results in policies regarding the implementation of EHR in the Canadian healthcare system.</p> <p>Discussion</p> <p>Given the imminence of an interoperable EHR in Canada, knowledge and evidence are urgently needed to prepare this major shift in our healthcare system and to oversee the factors that could affect its adoption and integration by all its potential users. This synthesis will be the first to systematically summarize the barriers and facilitators to EHR adoption perceived by different groups and to consider the local contexts in order to ensure the applicability of this knowledge to the particular realities of various Canadian jurisdictions. This comprehensive and rigorous strategy could be replicated in other settings.</p

Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review

<p>Abstract</p> <p>Background</p> <p>Electronic health record (EHR) implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users.</p> <p>Methods</p> <p>Covering a period from 1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if they reported on users' perceived barriers and facilitators to shared EHR implementation, in healthcare settings comparable to Canada. Studies in all languages with an empirical study design were included. Quality and relevance of the studies were assessed. Four EHR user groups were targeted: physicians, other health care professionals, managers, and patients/public. Content analysis was performed independently by two authors using a validated extraction grid with pre-established categorization of barriers and facilitators for each group of EHR users.</p> <p>Results</p> <p>Of a total of 5,695 potentially relevant publications identified, 117 full text publications were obtained after screening titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met the inclusion criteria. The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities.</p> <p>Conclusions</p> <p>This systematic review presents innovative research on the barriers and facilitators to EHR implementation. While important similarities between user groups are highlighted, differences between them demonstrate that each user group also has a unique perspective of the implementation process that should be taken into account.</p

Post-disaster social recovery: disaster governance lessons learnt from Tropical Cyclone Yasi

Post-disaster social recovery remains the least understood of the disaster phases despite increased risks of extreme events leading to disasters due to climate change. This paper contributes to advance this knowledge by focusing on the disaster recovery process of the Australian coastal town of Cardwell which was affected by category 4/5 Tropical Cyclone Yasi in 2011. Drawing on empirical data collected through semi-structured interviews with Cardwell residents post-Yasi, it examines issues related to social recovery in the first year of the disaster and 2 years later. Key findings discuss the role played by community members, volunteers and state actors in Cardwell’s post-disaster social recovery, especially with respect to how current disaster risk management trends based on self-reliance and shared responsibility unfolded in the recovery phase. Lessons learnt concerning disaster recovery governance are then extracted to inform policy implementation for disaster risk management to support social recovery and enhance disaster resilience in the light of climate change

Behaviour and cognition in motor neurone disease: a clinical characterisation of its overlap with frontotemporal dementia

Recent advances in genetics and pathology have supported the concept of motor neurone disease (MND) as a multisystem disorder overlapping with frontotemporal dementia (FTD), yet many questions remain unanswered particularly in relation to clinical issues; the existent literature on FTD-MND phenotype is limited and likewise the extent and pattern of cognitive and behavioural changes in MND is uncertain. This dissertation addresses early predictors of MND in patients presenting with FTD, the prevalence of behavioural changes in MND and their impact on carer burden, and finally characterises the pattern of cognitive dysfunction in MND patients in comparison to FTD.In the initial study, patients with FTD who subsequently developed MND were found to have a significantly higher rate of psychotic symptoms than those who did not develop MND. Otherwise, the behavioural features were identical. A second study involved MND patients and their carers NSW wide, and showed a substantial rate of behavioural symptoms in MND; most notably apathy. Moreover, the addition of these features increased the burden reported by carers. In the final empirical study, a consecutive series of MND clinic patients were given a neuropsychological battery, including tests sensitive to frontal dysfunction. The MND cohort was compared to a group of patients with FTD uncomplicated by MND. Overall, the profile of cognitive change was similar in the MND and FTD groups, but with less marked deficits in MND. A subgroup (25%) met clinical criteria for FTD while subtle frontal dysfunction was also found in the non demented MND group, where the Hayling test of inhibitory control emerged as the most sensitive measure of orbitofrontal impairment. Finally, a Rasch analysis ranked the patients on a same continuum based on their neuropsychological performance and behaviour, revealing a clear overlap between FTD and MND.In summary, this thesis provided a characterisation of the clinical profile of FTD-MND, identified early predictors of disease, established the prevalence of behavioural symptoms in MND and their impact on carer burden, and characterised the pattern of cognitive dysfunction in MND. These findings reinforce the concept of a clinical continuum between MND and FTD

TreeBasedKernels: an R-function for obtaining similarity kernels based on tree-based ensemble learners

This research was partially supported by the Bill and Melinda Gates Foundation via the STARS Grant Agreement (1094229-2014). We wish to express our gratitude to all the STARS partners and, in particular, to the ICRISAT-led team for organizing and collecting the required field data in Mali and to the STARS ITC team for pre-processing the WorldView-2 images. We would also like to acknowledge the European Commission Erasmus Mundus (SALAM2) for providing financial support for this research via a PhD grant to Ms. Azar Zafari. The dataset and code in this repository are related to following journal papers and Ph.D. thesis