Systems Science and Health: Using Analytical Approaches to Evaluate Healthcare Policy Decisions

This collection of presentations is from the mini-symposium entitled Systems Science and Health: Using Analytical Approaches to Evaluate Healthcare Policy Decisions. The focus of this symposium is on systems science applications to health research. Systems science is a collection of analytical computer simulation techniques which are used to evaluate optimize and improve healthcare delivery processes. These techniques account for the complexity of the healthcare system and healthcare processes by modeling nonlinear relationships between variables, the feedback effects, delays and soft variables. The analysis stresses heterogeneity of agents, resistance to change, potential unintended consequences, and behavioral emergence in complex systems. Such models use historical data to simulate the operations of healthcare systems providing an approximation of future outcomes. The presenters will discuss several different types of simulations methods, highlight recent advances, and describe funding opportunities from the National Institutes of Health. Examples from chronic disease patient chains, physician incentive redesign, clinic staffing and Emergency Department redesign will be discussed

A Theory of Organization-EHR Affordance Actualization

While organizations implement information technology (IT) to effect change, current theories of IT-associated organizational change pay insufficient attention to the change goals, the role of IT in organizational change, and the multilevel nature of change processes. We take a fresh look at IT-associated organizational change using grounded theory methods. Our longitudinal study of an electronic health record (EHR) system implementation in a multi-site medical group found user behaviors that did not fit well with existing theories. Instead, we found that they fit better with the concept of affordances from ecological psychology. In developing our affordance-based theory of IT-associated organizational change from our field data, we discovered three gaps in the affordance literature; namely, the lack of theory for (1) the process of actualizing an affordance’s potential, (2) affordances in an organizational context, and (3) bundles of interrelated affordances. This paper extends the theory of affordances to handle these three gaps and, in doing so, develops a mid-range theory for EHR-associated organizational change in a healthcare organization. While the resulting theory is specific to EHR implementations, it offers a template for other mid-range affordance-actualization theories and a more general affordance-actualization lens. Our affordance-actualization lens considers the materiality of the IT artifact, the non-deterministic process by which IT leads to organizational effects, the multilevel nature of IT-associated change processes, and the intentionality of managers and users as agents of change, and thus addresses important criteria for theories of IT effects in organizations. The paper also provides practical guidance for implementing EHR systems and other organizational systems

Utility Perception in System Dynamics Models

The utility perceived by individuals is believed to be different from the utility experienced by that individual. System dynamicists implicitly categorize this phenomenon as a form of bounded rationality, and traditionally employ an exponential smoothing function to capture it. We challenge this generalization by testing it against an alternative formulation of utility perception that is suggested by modern theories of behavioral sciences. In particular, the traditional smoothing formulation is compared with the peak–end rule in a simple theoretical model as well as in a medium-size model of electronic health records implementation. Experimentation with the models reveals that the way in which utility perception is formulated is important, and is likely to affect behavior and policy implications of system dynamics models

Autonomy and Electronic Health Records: Can We Have Both?

Physicians, as highly-trained professionals, have a sense of autonomy about how they perform their work. Electronic healthrecord (EHR) systems can be constraining and thus may affect physicians’ sense of autonomy. Such effects have beenreported in the literature, but they may be due to managers using the EHR to exercise more control. We are studying an EHRimplementation in an organization known for the autonomy it allows affiliated primary care practices. We are collectinglongitudinal, qualitative data and using grounded theory methods. We found that healthcare professionals think broadlyabout autonomy and want control over how their practices operate. After the implementation of the basic EHR, fewautonomy effects were observed, but more functionality is being implemented, including physician order entry and a patientportal, that may have stronger effects on autonomy. To test these possibilities, we will be collecting a second round of dataafter physician order entry is implemented

Electronic Health Records and the Changing Roles of Health Care Professionals: A Social Informatics Perspective

Our longitudinal study examines the changing roles of health care professionals (physicians, nurses, medical assistants, practice managers, and secretaries) before and after an EHR implementation in a large, multi-location group practice. We take a social informatics perspective and focus on the changing social identities of health care professionals as they adapt to their EHR-enabled roles. A year after go-live, a few professionals were still in reactive mode, trying to cope with the new system, but many others were actively shaping the technology and their roles in a variety of ways. A few went beyond shaping to find ways to provide additional value to themselves and to patients in ways that became possible only because of the EHR. In this paper, we explore these responses to the EHR as a basis for building theory about the potential for EHR systems to improve health care delivery, and the mechanisms by which that potential is realized

Photovoltaic technology in Southern Arava of Israel: an analysis of public acceptance

Israel's Southern Arava region has experienced a boom in solar infrastructure development since 2011. Public acceptance of renewable energy installations is key to their successful implementation. The objective of this paper is to understand the level of acceptance of solar installations among Southern Arava communities and identify the factors that contributed to the widespread implementation of solar infrastructure in the region. Surveys and semi-structured interviews were distributed to five local kibbutz communities and local solar developers to gauge their attitudes about renewable technology in general and their acceptance of solar installations in their community. The results point to strong acceptance of solar technology in this region. Several factors contributed to this high level of support including kibbutz co-ownership of solar assets, transparent communication between stakeholders, and the kibbutz decision-making structure